Basics of Obesity Screening and Counseling
Obesity screening and counseling are one of many distinct preventive services mandated by national and state regulations (US Dept. of Labor). The U.S. Preventive Services Task Force (USPSTF) recommends screening all adults for obesity. This screening also includes children of >6 years old.
CMS began reimbursing physicians for obesity counseling in November 2011, when they introduced the Healthcare Common Procedure Coding System (HCPCS) code G0447 (face-to-face behavioral counseling for obesity, 15 minutes). Intensive behavioral therapy for obesity consists of the following:
- Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed in kg/m2);
- Dietary (nutritional) assessment; and
- Intensive behavioral counseling and therapy promote sustained weight loss through high-intensity diet and exercise interventions.
Many providers, including chiropractors and physical and occupational therapists, can offer screening and counseling for obesity. To be reimbursed, the intensive behavioral intervention counseling must be provided by one of the provider specialties types such as General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Geriatric Medicine, Nurse Practitioner, Certified Clinical Nurse Specialist, and Physician Assistant.
For the purpose of this national Medicare coverage determination, the acceptable setting of care and primary care physician has been defined. The recommendations are for the intensive behavioral therapy to be administered in one of these acceptable places of service: a Physician’s Office, Outpatient Hospital, Independent Clinic, and State or local public health clinic.
Coverage for Medicare
For Medicare beneficiaries with obesity who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting, CMS covers:
- One face-to-face visit every week for the first month;
- One face-to-face visit every other week for months 2-6;
- One face-to-face visit every month for months 7-12 if the beneficiary meets the 3kg (6.6 lbs) weight loss requirement.
At the six-month visit, a reassessment of obesity and determining the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have achieved a reduction in weight of at least 3kg (6.6 lbs) over the first six months of intensive therapy.
This determination must be documented in the physician’s office records for applicable beneficiaries and must be consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 3kg (6.6 lbs) during the first six months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional six-month period. Medicare coinsurance and Part B deductible are waived for this service.
Preventative Counseling (CPT 99401-9941)
The standard obesity medicine behavioral counseling codes are 99401-99412. These codes are used to report services to promote health and prevent illness. Typically, the 5-A approach is used, i.e., ask, advise, assess, assist, and arrange. More specific counseling techniques, such as motivational interviewing and cognitive behavior therapy, may also be employed.
These codes are time-based, with increments of 15 minutes, and cover individual and group counseling. The wording on the time requirement states they require approximately 15 minutes. In time-based codes that do not specify ‘at least’ a specific time, the 50 percent rule applies. So, counseling for at least 7.5 minutes codes to a 99401 (approximately 15 minutes) and 22.5 minutes codes to a 99402 (approximately 30 minutes).
Reimbursement for 99401 is typically around $30-40. While not a princely sum, this is typically a service in addition to pharmacotherapy management. Apply a 25 modifier denoting a separate service on the same visit, earning an extra $35 on your standard 99214 reimbursements.
This coding subset is covered as a preventative service, so insurance pays the entire amount—no patient cost-sharing is allowed. Medicare has its separate code, G0447, which pays about 25 percent less and has more specific coding rules.
Health Behavior Assessment and Intervention Codes (CPT 96156, 96158)
These codes are similar to preventative service counseling but deal more with specific behavioral problems often encountered in an obesity medicine practice.
These services ‘…are used to identify and address the psychological, behavioral, emotional, cognitive, and interpersonal factors important to the assessment, treatment, or management of physical health problems,’ according to the American Psychological Association.
Consider these codes for specific behavioral problems, such as addiction, eating disorders, and environmental conditions that cause eating problems.
96156 is an untimed code used for assessing or reassessing a behavioral condition; it reimburses about three times more than a 99401 code. CPT code 96158 is for behavioral intervention.
While the code is for 30 minutes of counseling, the 50 percent rule applies. Be sure to document at least 16 minutes of therapeutic counseling. The code reimburses about twice as much as a 99401 code. There are also groups, extended time, and codes for counseling the family without the patient present.
Please note that the information on medical billing for obesity screening and counseling is provided as a reference only. Applicable reimbursement rates and billing guidelines may change according to the insurance carrier. If you need detailed assistance in medical billing for obesity screening and counseling, contact us at info@medicalbillersandcoders.com or 888-357-3226 for our billing services.
FAQs
Obesity screening and counseling typically include BMI measurement, dietary assessment, and intensive behavioral counseling aimed at promoting sustained weight loss through high-intensity diet and exercise interventions.
Bill using the appropriate CPT code for obesity counseling along with a diagnosis code that specifies obesity.
The CPT code for obesity counseling is G0447.
Providers such as General Practitioners, Family Practice Physicians, Internal Medicine specialists, Pediatricians, Nurse Practitioners, and Physician Assistants can offer obesity counseling. The service must be delivered in an approved setting like a physician’s office or outpatient hospital.
Medicare covers one face-to-face visit per week for the first month, bi-weekly visits for months 2-6, and monthly visits for months 7-12, provided the beneficiary has lost at least 3kg (6.6 lbs) in the first six months.
