Intensive Behavioral Therapy (IBT) for Obesity
Effective November 29, 2011, Medicare covers screening and intensive behavioral counseling for obesity by primary care providers in primary care settings for Medicare beneficiaries with a body mass index (BMI) ≥ 30kg/m2. The decision means registered dietitians can provide services as auxiliary personnel in primary care settings and bill the services as "incident to" in accordance with CMS guidelines (42 CFR § 410.26(b) or 410.27). CMS notes that the new benefit does not preclude primary care practitioners from referring eligible beneficiaries to other practitioners and/or settings for counseling; however, coverage remains only in the primary care setting. RDs should work collaboratively with primary care providers to provide this service.
Beginning January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) will now pay for Intensive Behavioral Therapy for Obesity for Medicare Part B beneficiaries as a group service, in addition to the existing coverage for individual services. In the Final Rule for the 2015 Medicare Physician Fee Schedule, CMS has established a new G-code for group obesity counseling, G0473 Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes. This new code will pay similar to the MNT group code 97804 and services must still be furnished in compliance with the existing criteria for the benefit.
This decision by CMS reflects consideration of comments submitted by the Academy on the Proposed Rules published this summer. The Academy continues to work with CMS and Congress to modify this benefit to get RDNs recognized as direct providers of this benefit.
For more detailed information about providing this service, see this Academy link:
Medicare Preventative Services - Obesity
Medicare Preventive Services