There are a few guidelines, but once you master them you will be on your way to helping
your patients with their health and their weight and helping your bottom line as well!!
BMI must be >30.0 and using the 5-A framework you must provide the following:
Assess, (behavioral health risks) Advise, (give personalized behavior change advice) Agree, (collaboratively select treatment goals and methods) Assist, (aid in achieving the agreed-upon goals) and Arrange (schedule follow-up contacts and support). I am sure you’re already doing this in your practice, and may not be getting paid for it.
If guidelines are met 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, and one face to face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement.
At the six month visit a reassessment and determination of weight loss must be performed to be eligible for additional face to face visits for an additional six months. A minimum of at least
3kg over the course of the first six months of intensive therapy must be achieved and documented. Beneficiaries, who do not achieve a weight loss of at least 3kg during the first six months, must have a reassessment of their readiness to change and BMI is appropriate after an additional six month period.
Use code G0447, face to face behavioral counseling for obesity 15 minutes along with one of the following ICD-9 codes for BMI 30.0 and over (V85.30-V85.39, V85.41-V85.45), you can bill the counseling code G0447 up to 22 times in a 12 month period. Do not bill this code with an evaluation management code, it will deny as inclusive to the evaluation management code.
Reimbursement for this code is in the range of $25-$38 per visit depending on the insurer.
We would recommend that you make up a form just for the obesity management sessions
In order to keep track of the timeframes, number of sessions, and weight reduction, in addition to charting into your EMR. This will allow you to have a quick, clear picture of the patients
Now you have all the information to help your patients with their weight management and create a new revenue stream for your practice as well!
Please fee free to give us a call if we can be of any help with this or any other billing questions you may have!! Call us toll free at 1.877-666.5279