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.”

Citations

• MM7641 obesity G0447
• CMS claims processing manual
• NCD for intensive behavioral threrapy for obesity

Incident to services

The MLN Matters billing guide notes that the service may be performed by auxiliary personnel, incident to a physician, PA, or NP.

“In addition, Medicare may cover behavioral counseling for obesity services when billed by the one of the provider specialty types listed above and furnished by auxiliary personnel under the conditions specified under our regulation at 42 CFR Section 410.26(b) (conditions for services and supplies incident to a physician’s professional service) or 42 CFR Section 410.27 (conditions for outpatient hospital services and supplies incident to a physician service).” Page 5 of MedLearn Matters article.

Here is a brief review of incident to requirements:

• Billing provider sees the patient that has an established plan of care
• Billing provider stays involved with the plan of care
• Billing provider is in the office when the service is performed
• Auxiliary personnel are an expense to the group that employs the billing provider
• The service takes place in a non-facility setting

Time must be documented in the record. For incident to services provided by staff, there should be documentation that the physician/NPP initiated the service, remains involved in the plan of care, and was in the office when the service was performed.

Document time spent performing the counseling in the medical record. As with all other services, don’t double count the time of another service counseling.

Specialty and site of service restrictions

This service may only be billed by these specialty providers:

• 01  General Practice
• 08  Family Practice
• 11  Internal Medicine
• 16  Obstetrics/Gynecology
• 37  Pediatric Medicine
• 38  Geriatric Medicine
• 42  Certified Nurse Midwife
• 50  Nurse Practitioner
• 89  Certified Clinical Nurse Specialist
• 97  Physician Assistant

The service must be provided in a primary care setting, in one of the following:

• 11 Physician’s office
• 19 Off-campus outpatient hospital
• 49 Independent clinic
• 71 State or local public health clinic

Bundling | G0447

G0447 is bundled into E/M services. It will require a modifier when both services are performed on the same day.

If reporting two services, use modifier 59 or 25 on G0447. Documentation should show two distinct services. Check with your MAC.

G0477 is not bundled into the “Welcome to Medicare” visit (IPPE), or the initial or subsequent annual wellness visits (AWV).

See Preventive Medicine Services – Medicare for complete details on Welcome to Medicare and initial and subsequent Medicare annual wellness visits. 

Diagnosis codes | G0447

• Z68.30–Z68.39, BMI 30-39, adult
• Z68.41–Z68.45, BMI 40 or greater, adult

The co-pay and deductible are waived for this service.