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Codes for Medicare Weight Loss Counseling?


True Blue
Salt Lake City, UT
Best answers
One of our physicians saw a patient for counseling for weight loss and per the patient, this is a new benefit. I have not heard of this yet. Have any of you? I'm wondering how Medicare wants this coded. Thanks for your help!


True Blue
Nashville AAPC Chapter
Best answers
Here is some good starter information in addition to the G0447. Documentation needs to be specific about the obesity of the patient and it is always a good idea to use the BMI V-codes with the primary Dx when billed.

What Does Medicare Cover?
Medicare will cover the following:
An initial assessment of your eating and activity habits
Counseling on diet and physical activity
Education on how to improve your diet and changes that will help you lose weight and improve your health
Follow-up visits to monitor your diet and weight loss progress

Important things to know:
Medicare will cover up to three hours of individual counseling services the first year, and two hours each year after that.
If your condition or treatment needs changing, you may be able to receive more services.
Your doctor must write an order (prescription) for the additional services each year they are needed.
You must receive the services from a qualified health professional who is Medicare-certified.
If you get your care from a Medicare Advantage or MediGap/Medicare Supplemental Plan, your plan may offer additional coverage.

What Will It Cost Me?
Your out-of pocket cost will depend on the type of Medicare plan you have. For example:
Medicare covers 80% of the approved amount for the service; you are responsible for the remaining amount.
If you have a MediGap/Medicare Supplemental Plan, call to find out what is covered by the plan. With a MediGap plans you will pay little or nothing.
If you have a Medicare Advantage Plan, call the plan for information on coverage. Remember the plan must cover at least what Medicare does; many MA Plans cover more.