The Centers for Medicare & Medicaid Services (CMS) recently informed contractors of an ICD-10 code range revision to previously communicated coverage for intensive behavioral therapy (IBT) for obesity.
Transmittal 2421 reiterates that beginning Nov. 29, 2011, Medicare beneficiaries with a body mass index (BMI) of 30 who are competent and alert at the time of counseling from a primary care physician can receive the following services without Medicare co-insurance or Part B deductible:
- One face-to-face visit every week for the first month
- One face-to-face visit every other week for months 2-6
- One face-to-face visit every month for months 7-12
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 months seven to 12, beneficiaries must have achieved a reduction in weight of at least 6.6 pounds over the course of the first 6 months of intensive therapy. This 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 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.
The revision is in business requirement 7641-04.1.3: For BMI 30.0 and over, ICD-10 codes are Z68.30-Z68.39.9 and Z68.41-Z68.45.
March 16th, 2012
Medicare is adding coverage for preventive services to reduce obesity. This adds to Medicare’s existing portfolio of preventive services that are now available without cost sharing under the Affordable Care Act. Screening for obesity and counseling for eligible patients by primary care providers in settings such as physicians’ offices are covered under this new benefit.
For a patient who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. The patient may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kg) during the first six months of counseling.
Read the final decision on the new national coverage determination for complete details.
December 2nd, 2011
An advisory committee to the U.S. Food and Drug Administration (FDA) took up for consideration, Dec. 3, a request by pharmaceutical company Allergan, Inc. to significantly lower how obese someone has to be to qualify for gastric banding surgery. In an 8-2 vote, the Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee agreed to recommend that the FDA extend the currently approved use of the LAP-BAND® system.
December 10th, 2010