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Medicare to reimburse for obesity screening and counseling

The Centers for Medicare and Medicaid Services (CMS) will reimburse you for preventive obesity screenings and counseling, but the agency has not instructed its contractors on how these services are to billed and paid, according to a spokeswoman.

Ellen B. Griffith, spokeswoman for CMS, wrote in an email to Medical Economics eConsult that CMS already has published that CPT code G0447, a 15-minute face-to-face behavioral counseling for obesity, has been assigned total non-facility RVUs of 0.74. The 2011 conversion factor is $33.9764. 

In addition, the agency has stated that CPT code G0449, a 15-minute annual face-to-face obesity screening is bundled.

“We do not make separate payment for this service,” Griffith said.

Both codes G0447 and G0449 are available on the CMS Web site.

Screening and counseling coverage is effective as of the decision date, so when contractors are ready to process the claims, physicians will be able to submit claims for service back to the date of coverage, according to the spokeswoman.

Patients with Medicare will not be charged for the screening or counseling, according to CMS. Screening for obesity and counseling for eligible beneficiaries by primary care providers are covered under this new benefit. For a beneficiary who screens positive for obesity with a body mass index greater than 30, the benefit includes one face-to-face counseling visit each week for 1 month and one face-to-face counseling visit every other week for an additional 5 months, according to CMS.

The beneficiary may receive one face-to-face counseling visit every month for an additional 6 months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds during the first 6 months of counseling.

More than 30% of men and women in the Medicare population are estimated to be obese, CMS reports.

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