HealthCare News

Behavioral Intervention Treatment for Obesity

Issue: #391 NOV2016

Topic: Coding/Billing

On October 23, 2015, Frequently Asked Questions (FAQs) about the Affordable Care Act Implementation (Part XXIX) were issued, by the Departments of Labor, Health and Human Services and the Treasury. In response to those FAQs, Blue Cross Blue Shield of North Dakota (BCBSND) expanded coverage of obesity services to 12 visits for behavioral interventions for weight management beginning January 1, 2016 and on anniversary and after for non-grandfathered benefit plans, when services are provided by a payable provider.

Grandfathered plans do not include benefits for behavioral or medical interventions for obesity.

BCBSND is providing the education below so members receive the benefit they are entitled under the Affordable Care Act.

The USPSTF recommendation specifies that intensive, multicomponent behavioral interventions include, for example, the following:

  • Group and individual sessions of high intensity (12 to 26 sessions in a year),
  • Behavioral management activities, such as weight-loss goals,
  • Improving diet or nutrition and increasing physical activity,
  • Addressing barriers to change,
  • Self-monitoring, and
  • Strategizing how to maintain lifestyle changes

Primary care providers should use the following codes for identifying the intensive, multicomponent behavioral interventions being provided for an obesity diagnosis.

G0447 – Face-to-face behavioral counseling for obesity, 15 minutes

G0473 – Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes

Licensed registered dieticians should use the following medical nutrition therapy codes:

97802 – Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes

97803 – Re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes

97804 – Group (2 or more individual(s)), each 30 minutes

Excluded from coverage are food and nutritional supplements, lab services, naturopathy, homeopathy, etc., solely provided as part of a medical weight loss program, services performed or ordered by a non-payable provider type, and any services which are exclusions or otherwise non-covered under the member’s benefit plan. These services should not be billed to BCBSND.

If other medically necessary services are provided during the same encounter and submitted to BCBSND, they must be supported by documentation of a medical diagnosis. In order for CPT® Evaluation and Management services to be submitted, all components as defined by CPT® need to be documented and met. Evaluation and Management (E/M) codes (CPT® 99201-99215) should not be utilized for behavioral interventions for obesity unless all components as defined by CPT® are documented and met. Preferred coding would be the G codes as identified above.