Medicare coverage for weight loss physician and healthcare provider visits must know facts for patients and providers

W8MD Medical Weight Loss Centers Of America - Lose Weight, Sleep Better & Live Longer!
Affordable Care Act Mandates Insurance Coverage For
Obesity
Affordable Care Act of 2010 mandates all insurances,
including Medicare, to provide full insurance coverage for
obesity!
In March, 2011, Medicare announced it will cover for Obesity
Prevention for eligible beneficiaries for up to 22 visits to a
qualified healthcare provider in the first 6 months. During this
period, if the beneficiary is able to lose about 6.6 lbs. Or
more, coverage will be extended to another 6 months.
1(800)W8MD-007 NE Philadelphia, And King Of Prussia in PA New York City Stamford, CT

What is Covered for Obesity Treatment And Counseling
By Medicare?
Dietary (nutritional) assessment; and Intensive behavioral
counseling and behavioral therapy to promote sustained
weight loss through high intensity interventions on diet and
exercise.
Intensive Behavioral Therapy for Obesity Medicare provides
coverage of IBT for obesity (BMI ≥ 30 kilograms per meter
squared) for Medicare beneficiaries:
► Who are competent and alert at the time that
counseling is provided; and
► Whose counseling is furnished by a
qualified primary care physician or other
primary care practitioner and in a primary
care setting.

IBT For Obesity Is A Stand Alone Benefit
The IBT for obesity benefit covered by Medicare
is a stand alone billable service. It is separate from
the Initial Preventive Physical Examination (IPPE)
or the Annual Wellness Visit (AWV). Medicare
beneficiaries may obtain IBT for obesity services
at any time following Medicare Part B enrollment,
including during their IPPE or AWV encounter.

What Should The Health Care Provider Do To Qualify
For Intensive Behavior Therapy For Obesity(IBT) For
Medicare?
Each IBT for obesity must be consistent with the 5A’s
approach adopted by the USPSTF. This approach includes:
1. Assess: Ask about or assess behavioral health risk(s) and
factors affecting choice of behavior change goals or methods;
2. Advise: Give clear, specific, and personalized behavior
change advice, including information about personal health
harms and benefits;
3. Agree: Collaboratively select appropriate treatment goals
and methods based on the beneficiary’s interest in and
willingness to change the behavior;
4. Assist: Using behavior change techniques (self-help and/or
counseling), aid the beneficiary in achieving agreed-upon
goals by acquiring the skills, confidence, and social
or environmental supports for behavior change, supplemented
with adjunctive medical treatments when appropriate; and
5. Arrange: Schedule follow-up contacts (in person or by
telephone) to provide ongoing assistance or support and to
adjust the treatment plan as needed, including referral to
more intensive or specialized treatment.

Primary Care Setting Defined For IBT For Obesity
For the purpose of this benefit, a primary care
setting is defined as one in which there is a provision of
integrated, accessible health care services by clinicians who
are accountable for addressing a large majority of personal
health care needs, developing a sustained partnership
with patients, and practicing in the context of family and
community. The following are not considered primary care
settings under this definition:
► Ambulatory surgical centers,
► Emergency departments,
► Hospices,
► Independent diagnostic testing facilities,
► Inpatient hospital settings,
► Inpatient rehabilitation facilities, and
► Skilled nursing facilities.
Medicare covers IBT for obesity provided in:
► An independent clinic,
► An outpatient hospital,
► A physician’s office, or
► A state or local public health clinic.

Who Are Primary Care Physicians and Practitioners For
Medicare That Qualify For IBT For Obesity?
For the purpose of the IBT for obesity benefit:
Primary Care Physician
A physician who has a primary specialty designation of:
Family practice,
General practice,
Geriatric medicine,
Internal medicine,
Obstetrics/gynecology, or
Pediatric medicine.
Primary Care Practitioner
A qualified non-physician practitioner is a:
Certified clinical nurse specialist,
Nurse practitioner, or
Physician assistant.
Primary care physicians’ and practitioners’
corresponding specialty codes apply when billing
professional claims. When billing institutional claims,
follow billing instructions based on your facility type.

Frequency Of Visits Covered For Obesity By Medicare
Medicare covers a maximum of 22 IBT for obesity sessions in
a 12-month period.
Medicare beneficiaries who meet the previously mentioned
criteria are eligible for:
► One face-to-face visit every week for the first month;
► One face-to-face visit every other week for months 2 – 6;
and
► One face-to-face visit every month for months 7 – 12, if
the beneficiary meets the 3 kg (6.6 pounds) weight loss
requirement during the first 6 months.

Intensive Behavioral Therapy for Obesity
At the 6-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 6 months,
beneficiaries must have achieved a reduction in weight of at
least 3 kg (6.6 pounds) over the course of the first 6 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 kg (6.6 pounds)
during the first 6 months of intensive therapy, a reassessment
of their readiness to change and BMI is appropriate after an
additional 6-month period.

Coinsurance or Copayment and Deductible
The beneficiary pays nothing (no coinsurance or copayment
and no Medicare Part B deductible) for IBT for obesity.
Financial responsibilities may apply for the beneficiary if the
provider does not accept assignment.
Documentation
Medical records must document all coverage requirements,
including the determination of weight loss at the 6-month
visit.

Coding and Diagnosis Information Procedure Codes and
Descriptors Use the following Healthcare Common
Procedure Coding System (HCPCS) code
HCPCS Code for IBT for Obesity
G0447 Face-to-face behavioral counseling for obesity, 15
minutes

Diagnosis Requirements
Use one of the following International Classification of
Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
screening (“V”) diagnosis code(s).
Diagnosis Codes for IBT for Obesity
ICD-9-CM Diagnosis Code Code Descriptor
V85.30 Body Mass Index 30.0 – 30.9, adult
V85.45 Body Mass Index 70 and over, adult
Learn more

How can W8MD Medical Weight Loss Centers Insurance
Physician Weight Loss Program Help Me Lose Weight?
Our physicians and staff are committed to offering a comprehensive
and individualized approach. W8MD physicians partner with each
patient to develop a custom weight management program to best
meet their individual needs.
If you are a bit overweight or obese, take long term medications for
cholesterol, blood pressure or diabetes but your doctor has nothing to
offer for weight loss other than simply say "lose weight", you may
want to consider W8MD!
Under the direction of a trained obesity medicine/weight loss
physician, W8MD Weight Loss Centers can help you overcome
obesity and to make a difference. The doctor’s of W8MD partner
with each patient to develop a custom weight management program
to best meet their individual needs taking into account their medical
history, lifestyle and goals.
Since weight and sleep go together, most of the W8MD centers are
able to address sleep issues such as snoring, obstructive sleep apnea,
narcolepsy, insomnia and restless leg syndrome to name a few.

Most Insurances Accepted
And the best part of the program is that most insurance’s cover the
doctor visits.
Check out our website at www.w8md.com to learn more about us. If
you have a little or a lot of weight to lose and want to do it without
surgery, set up fees and mandatory meal replacements or appetite
suppressants, think W8MD for weight loss.

Physician Weight Loss Franchise Opportunities
And, if you are a physician, with an interest in helping
your obese or overweight patients, and would like to add a
W8MD program at your office, please feel free to contact
us.
Most physicians have nothing to
offer their overweight patients other
than simply say"Lose Weight!" or
hand out a diet sheet. This is not
useful for most patients as obesity
needs a more thorough and structured approach!
Physicians Be A W8MD!
If you are a physician interested in helping your obese or
overweight patients lose weight safely and effectively using
evidence based non-surgical weight loss methods and work
with their insurance for the visits, W8MD's physician licensing program can
help.
As a Limited Time Offer, we are waiving all signup fees for
the first 50 physicians that Join W8MD Network of Weight Loss
Physicians. What are you waiting for? Call 1-800-W8MD-007.

W8MD Medical Weight Loss Centers That Accept
Insurances Including Medicare For Obesity
• NYC Insurance Weight Loss Center: 2003, Bath
Avenue, Brooklyn, NY, 11214 Ph: 1-718-946-5500
• Philadelphia Insurance Weight Loss Center: 1718,
Welsh Rd, Philadelphia, PA, 19115 Ph: 1-215-676-
2334
• King Of Prussia Weight Loss Center: 987 Old Eagle
School Rd, Wayne, PA, 19087 Ph: 1-800-986-3007
• Specialties: Weight Loss Service, Sleep Clinic, Sleep
Study Clinics, Sleep Apnea Clinic, Medical Weight Loss,
Weight Loss Pills, Weight Loss Supplements, Fast
Weight Loss Options, weight loss diet, weight loss
program, Lose Weight Philadelphia, Weight Loss NYC,
New York Weight Loss Clinic, Adipex, Phentermine,
Generic Combination of Phetermine and Topiramate (like
in Qsymia), Weight Loss Diet Pills, NYC Weight Loss
Service
• Cities Served: Philadelphia, King Of Prussia, Wayne,
Brooklyn, Staten Island, Manhattan, New York, New
York City, Queens, Long Island, Bronx, Bensonhurst.
• Counties Served: Chester, Philadelphia, Bucks,
Montgomery, Burlington, Kings, Richmond, Queens,
Manhattan, Bronx

W8MD Medical Weight Loss Centers That Are
Fee For Service
• W8MD at Optimal Health, 111 High Ridge Rd, Stamford,
CT 06905. Ph: 203-348-8805 Fax: 203-348-6398.
This email address is being protected from
spambots. You need JavaScript enabled to view it.
This Center is Fee For Service.
Call 1(800)W8MD-007 to learn more! You have nothing to
lose but your unwanted pounds.

W8MD Medical Weight Loss Telemedicine Program
If you do not have a W8MD location near you, you can
still consult with one of our weight loss physicians using
telemedicine. We offer a comprehensive telemedicine
nutrition, behavior and weight loss consultation with a
weight loss doctor for a low price of $150.00 USD for a 30
minute telemedicine consultation with certain limitations.
Call 1(800)W8MD-007 to learn more.
If you have insulin resistance, belly weight, elevated
triglycerides, history of high blood pressure etc. you might
be at risk for metabolic syndrome. An obesity medicine
physician can not only help you lose weight, but also
reduce the risk of diabetes, prediabetes and close to 50
different other obesity related problems by helping you
lose weight.
THINK W8MD (Weight MD) for Weight Loss!
http://www.w8md.com/

Disclaimer:
The information on this website is not intended to
diagnose, treat, cure, or prevent any disease. Always
consult with a licensed and trained physician before
attempting any weight loss!

Medicare coverage for weight loss physician and healthcare provider visits must know facts for patients and providers

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Medicare coverage for weight loss physician and healthcare provider visits must know facts for patients and providers