Originally Posted: August 18, 2023
Last Updated: June 30, 2025
Intensive Behavioral Therapy for Obesity Overview
Intensive Behavioral Therapy (IBT) for obesity is a preventive benefit for Medicare beneficiaries that have a body mass index (BMI) of 30 or greater. The service involves a nutrition assessment, as well as interventions on diet and exercise for weight loss and can be provided either individually or in a group.
There are several guidelines that you need to be familiar with before billing for this Medicare benefit as there are many restrictions regarding provider type, places of service, visit limits and weight loss that must be achieved to continue services.
Who Can Bill IBT for Obesity?
IBT can be furnished by a primary care physician as well as other primary care practitioners. This includes:
- General practice physicians
- Family practice physicians
- Internal medicine physicians
- Obstetrics-gynecology physicians
- Geriatrics physicians
- Nurse practitioners
- Certified clinical nurse specialists
- Physician assistants
The service can also be provided by auxiliary personnel, including registered dietitians, if billed “incident to” one of the above providers. Be aware, the Centers for Medicare and Medicaid Services (CMS) has specific guidelines for billing incident to that must be followed in order to be compliant.
For a variety of reasons, having auxiliary personnel, rather than the actual physician, render the service makes sense. Physicians have limited training in weight management counseling and generally have limited time. IBT has a lower pay rate than other medical services, so using a provider that costs less, makes it more likely to be a financially viable service.
Medicare will only pay for IBT when it is provided in a primary care setting, which can include the following places of service (POS):
- Office – 11
- Outpatient Hospital – 22
- Independent Clinic – 49
- Public Health Clinic – 71
Per CMS, this service can be provided via telehealth, so this would also include POS 10, Telehealth Provided in Patient’s Home.
IBT Procedure Code Descriptions
There are two different HCPCS codes for IBT. Note that one is for individual counseling and is a 15-minute unit, while the other is for a group and is a 30-minute increment.
- G0447: Individual, face-to-face behavioral counseling for obesity, 15 minutes
- G0473: Group, face-to-face behavioral counseling for obesity, 30 minutes
What ICD-10 Codes are Used to Bill Obesity Counseling?
When billing for IBT, use the ICD-10 code that corresponds with the patient’s BMI.
ICD-10 codes that can be used:
- Z68.30: BMI 30.0-30.9
- Z68.31: BMI 31.0-31.9
- Z68.32: BMI 32.0-32.9
- Z68.33: BMI 33.0-33.9
- Z68.34: BMI 34.0-34.9
- Z68.35: BMI 35.0-35.9
- Z68.36: BMI 36.0-36.9
- Z68.37: BMI 37.0-37.9
- Z68.38: BMI 38.0-38.9
- Z68.39: BMI 39.0-39.9
- Z68.41: BMI 40.0-44.9
- Z68.42: BMI 45.0-49.9
- Z68.43: BMI 50.0-59.9
- Z68.44: BMI 60.0-69.9
- Z68.45: BMI 70.0 or greater
How Many Sessions of IBT are Covered?
Medicare will pay for 22 units of IBT in a 12 month period. Note that this is a 12 month period, rather than a calendar year, which is how Medicare benefits are based for Medical Nutrition Therapy (MNT).
IBT is to be provided on the following schedule:
- Weekly visits for the first month
- Biweekly visits for months 2 through 6
- Monthly visits for months 7 through 12 (if patient meets specific requirements)
This schedule is what Medicare provides; however, they do not penalize for following a different schedule, as long as no more than 22 units are billed within a 12 month period.
After 6 months of IBT services, the patient must lose 3 kilograms (6.6 pounds) to be able to continue with months 7 through 12 of services.
After completing the 12 months of IBT, if the patient’s BMI is still 30 or greater, they would be eligible to start the services all over again.
If the patient does not meet the weight loss requirement, IBT services will have to be discontinued. After a 6 month waiting period, patient readiness and the BMI requirement can be reassessed and services can begin again. In this situation, it is important to make sure that no more than 22 units are being billed during any 12 month period.
How Many Units Can Be Billed for One Session?
Per the CMS Medically Unlikely Edit (MUE), HCPCS code G0447 has a limit of 2 units per date of service and G0473 has a limit of 1 unit. This means appointments must be limited to about 30 minutes.
However, dietitians have reported denials for IBT when billing for more than one unit on a date of service. Per correspondence with the Academy of Nutrition and Dietetics (AND) in May of 2025, they are working with CMS to get clarification on this issue.
Can Private Practice Dietitians Bill for IBT?
Private practice dietitians generally cannot bill for IBT as it has to be billed incident to another provider type, such as a physician or advanced practice provider. You could potentially have a unique situation where you employ this type of provider or have some sort of other arrangement where they are directly supervising you per CMS’s guidelines, but this would be uncommon.
If the Treat and Reduce Obesity Act (TROA) were to be passed, this would allow more provider types, such as dietitians, to directly provide IBT, therefore, it could be furnished in a dietitian private practice setting.
Private Insurance Company Coverage IBT
IBT for obesity is a specific Medicare Part B benefit available to people that have Original Medicare and Medicare Advantage Plans. Other payers and plans may or may not cover this service.
Most commercial plans have MNT coverage for obesity, so it generally makes more sense for dietitians to bill with these procedure codes instead. The MNT codes have higher reimbursement rates, so using CPT codes 97802, 97803 and 97804, is advisable. These codes can be billed directly under the dietitian’s NPI number, rather than billing incident to another provider.
Reimbursement Rates
Unlike with private payers, Medicare fee schedules are public information, which can be found using the CMS Search the Physician Schedule Look-Up Tool.
You can look up your specific locality, but the national payment amount in 2025 for one 15-minute unit of G0447 is $31.70. This is a significant increase from the 2024 national payment amount of $25.30.
Note that the payment amount will be affected by the supervising provider type. If a physician is the supervising provider, 100% of the fee schedule will be paid out. If an advanced practice practitioner, such as a nurse practitioner, is the supervising provider, only 85% of the fee schedule will be paid out.
Since IBT is a preventive visit, Medicare will pay the full amount owed, with no patient responsibility. This is unlike many other Part B services in which the patient owes 20%.
IBT Limitations and Criticism
CMS does not make it easy to provide this service and IBT has several limitations. In fact, a 2023 study showed that only 1.2% of primary care physicians are providing IBT for obesity to their patients, and only a fraction of a percent of Medicare beneficiaries are receiving IBT.
Provider Type Limitation
Dietitians, obesity medicine specialists, and bariatric surgeons are unable to provide IBT, yet these are some of the providers that are best fit to provide this service. It seems odd these provider types weren’t included as they already talk to patients about obesity on a regular basis.
Weight Loss Requirement
IBT can only be continued after six months if the patient loses at least 6.6 pounds. If not, the patient has to wait six months to begin again.
While 6.6 pounds doesn’t necessarily sound like a lot, this is not going to be possible for every patient in every situation. There could be unforeseen injuries, illnesses, medical procedures, personal situations, medication changes or other things that come up that make losing this amount of weight extremely challenging.
In practice, weight loss requirements sound reasonable, but they can sometimes make patients adopt unhealthy behaviors. I will never forget meeting with an elderly patient consuming about 500 calories per day because her doctor recommended she lose 10 pounds before they meet again. Her appointment was approaching and she hadn’t met the goal, so she severely restricted her diet. She did not see the harm in what she was doing due to the explained health benefits of weight loss and wanting to please her provider.
Whenever there are weight loss requirements for something, I always think about those patients that were gaining a significant amount of weight prior to the intervention. If someone was gaining 2 pounds a month prior to IBT and then started losing 0.5 pounds a month, this would be a very meaningful weight change. However, it would still not be good enough to continue services based on the generalized weight loss requirement for this therapy.
It would be an uncomfortable situation to tell a patient they did not successfully lose enough to continue services and could really decrease their morale and motivation. I’m sure this would not positively impact the patient’s longterm weight loss efforts.
Limited Number of Units for One Session
While it’s somewhat unclear if 1 or 2 units can be billed at a time for G0447, either way, in my opinion, this is not enough time to gather information from the patient and also provide feedback and come up with specific goals.
It is typical for dietitians to spend an hour or more with a patient at a first appointment to complete a full assessment. There is nothing “intensive” about spending 20 minutes with a patient. It would be near impossible for any provider to assess a patient’s intake, physical activity, attitudes, knowledge, stage of change, and barriers to success in this short of an appointment.
I could see both the provider and patient feeling unsatisfied with such a short appointment, and I question what kind of retention rates there are with this service. I could see a patient leaving the appointment with more questions than answers and deciding not to return.
In Summary
Intensive Behavior Therapy for obesity is a preventive benefit available to people with Medicare Part B.
If the service is provided individually, then it should be billed with HCPCS code G0447. If it’s provided in a group, it should be billed with HCPCS code G0473.
IBT for obesity needs to be provided in a primary care setting. If auxiliary personnel, such as a dietitian, is providing the service, it will need to be billed incident to a physician or other primary care provider.
References:
Intensive Behavioral Therapy for Obesity
Intensive Behavioral Therapy for Obesity (210.12)
Medicare Claims Processing Manual – Chapter 18: Preventive and Screening Services
MUE Files for Individual Practitioners
Pass the Treat and Reduce Obesity Act (TROA) to Advance Quality & Equitable Obesity Care
Hello,
Thanks so much for the extremely helpful info in this article! Any updates from the Academy on CMS’s answer to the number of units we can bill per visit? I’m trying to implement this in our practice and it would make a huge difference to be able to bill for 2 units vs. 1 per visit.
No unfortunately. They recommend contacting your MAC if they are only paying for 1 unit as they should be paying 2.