What is Intensive Behavioral Therapy for Obesity?
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.
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, 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 services 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
What Procedure Codes are Used to Bill Obesity Counseling?
There are two different HCPCS codes for IBT:
- 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. Use the original BMI for all visits, but be sure to document the current BMI as well.
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.
Dietitians have reported claims being denied if they bill for more than 1 unit per visit. However, the Academy of Nutrition and Dietetics (AND) states that starting in October 2017, CMS is to pay for up to 2 units of IBT in a single visit.
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.
Do Private Insurance Companies Cover 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 may make 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.
Unlike with private payers, Medicare fee schedules are public information, which can be found using the CMS Search the Physician Schedule Look-Up Tool.
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.
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.
The diagnosis code should correspond with the patient’s BMI at the time of the initial IBT visit. For example, if the patient has a BMI of 36 at the initial visit, then the ICD-10 code of Z68.36 will be used for all visits, until a new year of IBT is provided.
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.