G0447 face-to-face behavioral counseling for obesity, 15 minutes

G0473 Face-to-face behavioral counseling for obesity, group (2-10) 30 minutes

Medicare pays for ongoing face-to-face behavioral counseling for patients with a body mass index (BMI) of ≥ 30, who are alert and able to participate in counseling. The service may be performed by a physician or non-physician practitioner (NPP), but it is also allowed to be performed by medical practice staff incident to the services of a physician or an NPP, assuming all incident to requirements are met and you are in a non-facility setting. You can assure yourself it can be done incident to by downloading the MLN Matters article, linked below.

The service consists of screening for obesity, dietary assessment and intensive behavioral counseling and behavioral therapy, for eligible patients.  The patient must have a BMI  of ≥ 30 to be eligible for the service.

Frequency limits for G0447

There are frequency limits for this service:

• One face-to-face visit every week for the first month;
• One face-to-face visit every other week for months 2-6; and
• One face-to-face visit every month for months 7-12, if the beneficiary meets if the 3kg (6.6 lbs) weight loss requirement during the first 6 months.

Intensive behavioral intervention | G0447

According to the MM7641 revised article, intensive behavioral intervention for the treatment of obesity should align with the 5 As:

1. Assess: Ask about/assess behavioral health risk(s) 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 the patient’s interest in and willingness to change the behavior.
4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the 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 the treatment plan as needed, including referral to more intensive or specialized treatment.

From CMS’s MedLearn Matters article (emphasis theirs):

“At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss should be performed. To be eligible for additional face-to-face visits occurring once a month for months 7-12, beneficiaries must have achieved a reduction in weight of at least 3kg (6.6 lbs.), over the course of the first 6 months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 3kg (6.6 lbs.) during the first 6 months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.”