Show On November 29, 2011, CMS announced its decision to include coverage for obesity screening and counseling services for Medicare beneficiaries.[1] This new coverage for Medicare beneficiaries is another tool aimed at emphasizing prevention and wellness by CMS, which has already implemented coverage of certain preventive services and screenings as part of the Affordable Care Act.[2] An estimated 30% of men and women in the Medicare program are considered medically obese, defined as having a Body Mass Index (BMI) of at least 30 kg/m.² Patients who are obese are at higher risk of developing other chronic conditions, including heart disease and diabetes. What is Covered Beneficiaries eligible for Medicare Part A or Medicare Part B are entitled to preventive weight-control services including screening for obesity, dietary assessment, and behavioral counseling or therapy to promote sustained weight loss. For beneficiaries with obesity as defined above, Medicare will cover:
The beneficiary must be re-assessed at the six month visit, where a determination of amount of weight lost must be performed. If the beneficiary has achieved a weight loss of at least 6.6 pounds, CMS will continue to cover additional face-to-face visits once per month for an additional six months. If the beneficiary has not achieved weight loss of at least 6.6 pounds, they can be reassessed for BMI and lifestyle changes after a six month period.[3] Costs and Disparities Medicare and private insurers currently pay more for patients with obesity than for patients with normal weight.[4] Preventing
obesity through screening and counseling will help bring down overall healthcare costs by preventing the development of such obesity-related chronic conditions as cardiovascular disease, diabetes, kidney disease, and more. Advocates should be aware of this new addition to Medicare’s free preventive services and should reach out to their networks to help inform beneficiaries and their families of this important benefit. You must be logged in to bookmark pages. Body mass index (BMI) is a measure of body fat in adults. BMI screenings and follow-up behavioral counseling can help you lose weight if your BMI is high. Eligibility Medicare
Part B covers BMI screenings and behavioral counseling to help you lose weight if you are obese. You are obese if you have a BMI of 30 or higher. Once your doctor diagnoses you as obese, you can qualify for behavioral counseling and therapy to help you lose weight and sustain weight loss through proper diet and exercise. Medicare covers a series of visits for behavioral counseling:
*After your first six months of therapy, you will be re-screened for obesity. During this re-screening, your doctor will determine how much weight you have lost since your initial screening. To be eligible for additional face-to-face visits with your doctor during months 7-12 of behavioral therapy, you must lose at least 6.6 lbs (3 kg) during the first six months of therapy. If you do not lose at least 6.6 lbs during the first six months of behavioral visits, your therapy may end. Your doctor can reassess you for another Medicare-covered obesity screening after six months have passed. Costs If you qualify, Original Medicare covers BMI screenings and behavioral counseling at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover BMI screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service. During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit. What is obesity screening?An obesity screening is used to find out if you or your child is at an unhealthy weight. If the screening shows that you or your child is overweight or has obesity, your provider will check to see if there is medical issue causing the excess weight.
What may limit the number of times a given procedure can be billed?Insurance Handbook for the Medical Office Ch. 12,13,14,15,16 Pretest. Which program includes managed care and private fee for service?Medicare Advantage (Medicare Part C), formerly called Medicare+Choice, includes managed care and private fee-for-service plans that provide contracted care to Medicare patients.
How do I know if I have Medicare?You will know if you have Original Medicare or a Medicare Advantage plan by checking your enrollment status. Your enrollment status shows the name of your plan, what type of coverage you have, and how long you've had it. You can check your status online at www.mymedicare.gov or call Medicare at 1-800-633-4227.
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Obesity screening and counseling are medicare preventive health benefits
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