Avoiding Obesity Counseling Denials


In 2015 Obesity Counseling G codes (G0447 Face-to-face behavioral counseling for obesity, 15 minutes and G0473 Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes) were reported 240,913 times but were denied approximately 80% of the time.

There are a few key points to consider when providing and documenting for these services. First and foremost is the type of provider. The National Coverage Determination (NCD) requires the services are provided by a qualified primary care physician or other primary care practitioner in a primary care setting. The counseling can be provided by qualified auxiliary staff (e.g. dietitian) under the direct supervision of a primary care provider. Secondly these codes have a frequency limitation. • 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 3kg (6.6 lbs.) weight loss requirement during the first 6 months.

Medlearn Matters MM7641 clearly defines the types of providers designated as primary care providers, frequency of services, and supporting diagnosis codes.

For more information on how to get it right click the following link: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7641.pdf