Intensive Behavioral Therapy (IBT) for Obesity

HCPCS/CPT Codes

  • G0447 - Face-to-face behavioral counseling for obesity, 15 minutes
  • G0473 - Face-to-face behavioral counseling for obesity, group (two–10), 30 minutes

Frequency

  • First month: One face-to-face visit every week
  • Months two - six: One face-to-face visit every other week
  • Months seven - 12: One face-to-face visit every month if certain requirements are met

Notes:

  • At the six-month visit, reassessment of obesity and determination of amount of weight loss must be performed
  • To be eligible for additional face-to-face visits occurring once a month for additional six months, Medicare beneficiaries must have lost at least three kg
  • For Medicare beneficiaries who do not achieve weight loss of at least three kg during first six months, reassessment of their readiness to change and Body Mass Index (BMI) is appropriate after additional six-month period

Diagnosis Code

  • Z68.30 - Body mass index 30.0-30.9, adult
  • Z68.31 - Body mass index 31.0-31.9, adult
  • Z68.32 - Body mass index 32.0-32.9, adult
  • Z68.33 - Body mass index 33.0-33.9, adult
  • Z68.34 - Body mass index 34.0-34.9, adult
  • Z68.35 - Body mass index 35.0-35.9, adult
  • Z68.36 - Body mass index 36.0-36.9, adult
  • Z68.37 - Body mass index 37.0-37.9, adult
  • Z68.38 - Body mass index 38.0-38.9, adult
  • Z68.39 - Body mass index 39.0-39.9, adult
  • Z68.41 - Body mass index 40.0-44.9, adult
  • Z68.42 - Body mass index 45.0-49.9, adult
  • Z68.43 - Body mass index 50.0-59.9, adult
  • Z68.44 - Body mass index 60.0-69.9, adult; or
  • Z68.45 - Body mass index 70 or greater, adult

Coverage

  • Obesity (BMI = 30 kilograms per meter squared)
  • Competent and alert at time counseling is provided
  • Counseling furnished by qualified primary care physician or other primary care practitioner in primary care setting

Counseling Requirements

Counseling is to be completed based on Five As Approach

  1. Assess: Ask about or assess behavioral health risks and factors affecting choice of behavior change goals/methods
  2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits
  3. Agree: Collaboratively select appropriate treatment goals and methods based on patient's interest in and willingness to change behavior
  4. Assist: Using behavior change techniques (self-help and/or counseling), aid patient in achieving agreed upon goals by acquiring skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate
  5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust treatment plan as needed, including referral to more intensive or specialized treatment

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0447 and G0473

Resources

Last Updated Mar 20 , 2024