The prevalence of obesity among adults in the United States in 2023 was around 40.3% and is a growing issue, according to the
Intensive behavioral therapy (IBT) for obesity consists of a screening and assessment. IBT also involves regular face-to-face behavioral counseling to help with diet. Plus, IBT includes support for physical activity to promote weight loss for adults with obesity.
Medicare covers obesity counseling, like IBT, when a healthcare professional administers the counseling in a primary care setting, like a doctor’s office.
The Centers for Medicare & Medicaid Services (CMS) implemented coding for IBT in 2011 to encourage healthcare professionals to utilize and bill for the service.
If you have obesity, Medicare covers:
- 1 face-to-face visit every week for the first month
- 1 face-to-face visit every other week for months 2 to 6
- 1 face-to-face visit every month for months 7 to 12 if the individual meets the 3 kg (6.6 lbs) weight loss requirement in the first 6 months
A second assessment takes place at the 6-month visit. You must have met the 3 kg weight loss requirement to be eligible for a further 6 months of face-to-face visits and counseling. The healthcare professional must document this, and if the requirement is not met, you can be reassessed in 6 months.
As long as the healthcare professional accepts the Medicare assignment, you’ll pay nothing out of pocket for obesity counseling and assessments.
When a healthcare professional accepts the assignment, they agree to take the Medicare-approved amount as full payment for their services.
Both obesity screenings and follow-up counseling, like IBT, are considered preventive care by Medicare. This means they fall under Part B coverage.
Medicare covers body mass index (BMI) screening for beneficiaries with obesity or who may have obesity. You’re considered to have obesity if your BMI is 30 or higher.