Wiki Obesity Counseling - One Time or Annual Benefit?

[suemt]

I haven't been able to find a definitive answer on this. Is the new Medicare Obesity counseling services a one time benefit, or can the counseling continue past the initial 12 month counseling period outlined in the NDC?

Thanks, as always, for the wonderful feedback this group always provides!

Sue

 

[Pam Warren]

Per Med Learn Matters article MM7641 (revised March 2012), which I've attached, this service allows 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, provided the beneficiary meets a 6.6 lb. weight loss during the first 6 months. Report G0447 (Face to Face Behavioral Counseling for Obesity, 15 minutes) for each quarter hour that is documented for counseling.

Also in the article is an explanation of the requirements for this service (BMI 30.0 and over), the appropriate diagnosis, and documentation guidelines for intensive behavioral therapy (IBT) intervention, using the 5A framework (Assess, Advise, Agree, Assist, Arrange).

So, in typical CMS style, you have to meet certain criteria and document carefully within a pre-determined framework in order to bill out these services. It's so labor intensive at this point, that my physicians felt the work involved in designing an EHR template wasn't worth the reimbursement.

 

[suemt]

Thank you, Pam. All that information has been well published and distributed, but I did find what I was looking for in the article:

Frequency Limitation
Effective July 2, 2012, for claims processed with dates of service on or after November 29, 2011, Medicare will pay for G0447 with an ICD-9 code of V85.30-V85.39, V85.41-V85.45, no more than 22 times in a 12-month period. Line items on claims beyond the 22 limit will be denied using the following codes: (Note: When applying this frequency limitation, a claim for the professional service and a claim for a facility fee will be allowed.)

I would be interested in any feedback people may have on getting paid for these services, especially for any non-Medicare payors.