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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 (2–10), 30 minutes

Covered ICD-10 Codes for CPT G0447 & G0473

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

  • Z68.30 - Body mass index [BMI] 30.0-30.9, adult
  • Z68.31  -Body mass index [BMI] 31.0-31.9, adult
  • Z68.32 - Body mass index [BMI] 32.0-32.9, adult
  • Z68.33 - Body mass index [BMI] 33.0-33.9, adult
  • Z68.34 - Body mass index [BMI] 34.0-34.9, adult
  • Z68.35 - Body mass index [BMI] 35.0-35.9, adult
  • Z68.36 - Body mass index [BMI] 36.0-36.9, adult
  • Z68.37 - Body mass index [BMI] 37.0-37.9, adult
  • Z68.38 - Body mass index [BMI] 38.0-38.9, adult
  • Z68.39 - Body mass index [BMI] 39.0-39.9, adult
  • Z68.41 - Body mass index [BMI] 40.0-44.9, adult
  • Z68.42 - Body mass index [BMI] 45.0-49.9, adult
  • Z68.43 - Body mass index [BMI] 50.0-59.9, adult
  • Z68.44 - Body mass index [BMI] 60.0-69.9, adult
  • Z68.45 - Body mass index [BMI] 70 or greater, adult
Require primary ICD Codes for above diagnosis,
  • E66.9 - Obesity, unspecified
  • E66.8 - Other obesity
  • E66.3 - Overweight
  • E66.2 - Morbid (severe) obesity with alveolar hypoventilation
  • E66.1 - Drug-induced obesity
  • E66.09 - Other obesity due to excess calories
  • E66.01 - Morbid (severe) obesity due to excess calories

Who Is Covered

The Medicare beneficiaries requires the following information to meat the medical necessity 

  • Obesity (Body Mass Index [BMI] ≥ 30 kilograms [kg] per meter squared)
  • Competent and alert at the time counseling is provided
  • Counseling furnished by a qualified primary care physician or other primary care practitioner in a primary care setting

Frequency

  • First month: one face-to-face visit every week
  • Months 2–6: one face-to-face visit every other week
  • Months 7–12: one face-to-face visit every month if certain requirements are met.

At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.

To be eligible for additional face-to-face visits occurring once a month for an additional 6 months, Medicare beneficiaries must have lost at least 3 kg.

For Medicare beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

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