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Insurance coverage for weight managementRead more about Medicare coverage for obesity.
What is intensive behavioral therapy for obesity?
CMS states that intensive behavioral therapy for obesity consists of the following:
- Screening for obesity in adults using the measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed kg/m2).
- Dietary (nutritional) assessment.
- Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.
Who is eligible to receive these services?
To be eligible for intensive behavioral counseling under the Medicare benefit, patients must be Medicare Part B beneficiaries with a BMI equal to or greater than 30 kilograms per meter squared and competent and alert at the time that counseling is provided. Counseling must be furnished by a qualified primary care physician or other primary care practitioner in a primary care setting.
What services does the benefit cover?
- One face-to-face visit every week for the first month.
- One face-to-face visit every other week for months two through six.
- One face-to-face visit every month for months seven through 12, provided the beneficiary has lost at least 3 kilograms (6.6 pounds) over the course of the first six months of intensive therapy.
At the six-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have achieved a reduction in weight of at least 3 kilograms (6.6 pounds) over the course of the first six 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 3 kilograms (6.6 pounds) during the first six months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional six-month period.
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