Obesity & Weight Management and counseling are two of several distinct preventive services required by federal and state regulations. The US Preventive Services Task Force recommends screening all adults for obesity, including children over the age of six. When CMS introduced Healthcare Common Procedure Coding System (HCPCS) code G0447 in November 2011, it began reimbursing physicians for obesity counseling.
Dietary (nutritional) analysis, screening for obesity using BMI, Intensive behavioral counseling, and therapy to promote long-term weight loss through high-intensity diet and exercise interventions are the parts of intensive behavioral therapy for Obesity & Weight Management.
Obesity screening and counseling can be provided by a wide range of providers, including chiropractors, physical and occupational therapists. To be reimbursed, the intensive behavioral intervention counseling must be delivered by one of the following provider Specialities: General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Geriatric Medicine, Nurse Practitioner, Certified Clinical Nurse Specialist, or Physician Assistant. A suitable setting of care and primary care physician has been identified for this national Medicare coverage determination. Intensive behavioral therapy should be provided in one of the following settings: a physician’s office, an outpatient hospital, an independent clinic, or a state or local public health clinic.
Obesity & Weight Management Coverage for Medicare
CMS covers the following services for Medicare beneficiaries with obesity who are competent and alert at the time of counseling and who are counseled by a qualified primary care physician or other primary care practitioners in a primary care setting:
- 1 face-to-face visit every week for the first month
- 1 face-to-face visit every other week for months 2-6
- 1 face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement
Obesity & Weight Management Preventative Counseling
The standard obesity medicine behavioral counseling codes are 99401-99412. These codes are used to report services that promote health and help people stay healthy. Typically, the 5-A’s approach is used, i.e. ask, advise, assess, assist, and arrange. Counseling techniques such as motivational interviewing and cognitive behavior therapy may also be used. These codes are time-based, with 15-minute increments, and they cover both individual and group counseling. They require approximately 15 minutes, according to the wording on the time requirement. The 50 percent rule applies to time-based codes that do not specify ‘at least’ a specific time. So, counseling for at least 7.5 minutes codes to a 99401, and 22.5 minutes codes to a 99402.
Reimbursement for 99401 is typically in the $30-40 range. While not cheap, this is typically a service provided in addition to pharmacotherapy management. Implementing a 25 modifier, which denotes a separate service on the same visit, will earn you an additional $35 on your standard 99214 reimbursements. Even better, because this coding subset is covered as a preventative service, insurance will cover the entire cost—no patient cost-sharing is permitted. Medicare has its code, G0447, which pays about 25% less and has more specific coding rules.
Health Behavior Assessment and Intervention Codes
These codes are similar to preventative service counseling, but they focus on specific behavioral issues that are commonly encountered in an obesity medicine practice. According to the American Psychological Association, these services ‘can be used to identify and address the psychological, behavioral, emotional, cognitive, and interpersonal factors important to the assessment, treatment, or management of physical health problems.’ Consider these codes for specific behavioral issues such as addiction, eating disorders, and environmental conditions that cause eating problems.
The untimed code 96156 is used for an assessment or reassessment of a behavioral condition, and it reimburses approximately three times more than the 99401 code. Behavioral intervention is coded as CPT 96158. While the code only applies to the first 30 minutes of counseling, the 50 percent rule still applies. Make a note of at least 16 minutes of therapeutic counseling. It reimburses probably twice as much as a 99401 code. There are also group codes, extended time codes, and codes for counseling the patient’s family when the patient is not present.
Why Outsource Your Obesity & Weight Management Billing Services
Obesity & Weight Control Physicians team up with a team of dieticians, psychotherapists, and behavioral specialists to ensure that patients are on the right program for them. Similarly, when you outsource your medical billing, your practice’s finances are in the hands of a team that ensures your claims are quickly and accurately reimbursed.
A medical billing partner can help you streamline your medical billing process and work with you on each unique case in your practice. Allow your revenue cycle partner to focus on maximizing your reimbursements while you treat each patient to the best of your ability.
Zee Medical Obesity & Weight Management Billing Services
Zee Medical Billing offers a variety of services designed to support weight management practices in any way possible, including monthly reports. Our experienced medical billing staff works hard to maximize your cash flow. Our Obesity and Weight Management medical billing services include the following:
- Medical Billing
- Financial reporting
- Revenue cycle management solutions
- Accounts receivable and denial management
- optimization for meaningful use
- Security risk assessments
- Mobile and remote connectivity
- 24/7 assistance
If you need detailed help in Obesity & Weight Management Billing Services___
Get a free no-sting attached billing services quote from ZEE Medical Billing for your practice.