Does Medicare Cover Obesity Behavioral Therapy?

Obesity is associated with many chronic conditions, including cardiovascular disease, musculoskeletal conditions and diabetes.

Obesity behavioral therapy is a preventive service that allows your doctor to discuss your weight with you, advise you on diet and exercise, monitor your progress and provide support during regular visits.

Findings from several randomized studies — including the Diabetes Prevention Program — show that regular and frequent obesity counseling visits can help people lose weight and change long-term behavior.

In 2011, the U.S. Centers for Medicare and Medicaid Services, or CMS, introduced Medicare coverage for obesity counseling. It utilizes intensive behavioral therapy and takes place through structured visits over a 12-month period.

Medicare covers obesity screenings and behavioral counseling for beneficiaries with a BMI of 30 or more.

Each counseling session lasts about 15 minutes. You must be competent and alert when counseling is provided.

This counseling must be provided by a primary care doctor, nurse practitioner, clinical nurse specialist or physician assistant in a primary care setting — such as a doctor’s office.

Intensive obesity counseling sessions can also be provided via telehealth services.

Dietitians, psychologists and exercise physiologists are not listed as qualified providers for this service, despite their expertise in obesity treatment.

Obesity screenings and counseling are covered by Original Medicare.

Medicare Advantage plans also cover this service for beneficiaries who qualify.

At your six-month visit, you must undergo a reassessment to determine how much weight you’ve lost.

To be eligible for an additional six months of counseling visits, you need to lose at least 3 kilograms — or about 6.6 pounds — during your first six months of intensive therapy.

If you don’t reach the minimum weight loss goal, you still get another chance.

However, you will need to wait another six months before Medicare will pay for you to try again.

You can make an unlimited number of attempts, so long as your BMI is still 30 or greater and six months have passed since your last attempt.

You pay nothing for obesity screenings and behavioral therapy so long as you have a BMI of 30 or more and your qualified health care professional accepts Medicare.

There are no coinsurance payments or deductibles because the Patient Protection and Affordable Care Act waives deductibles and coinsurance for certain preventive services.

This therapy is also available if you’re enrolled in a Medicare Advantage plan. But you will likely need to see a doctor inside your plan’s network to receive coverage.

In addition to obesity screenings and counseling, Medicare offers other services, programs and treatments that can help you lose weight and achieve a healthier lifestyle.

There are several weight-loss services Medicare does not cover, including weight loss programs such as Weight Watchers and FDA-approved diet pills.

While Medicare covers most bariatric surgery procedures for those who qualify, it does not cover them all, including gastric balloon surgery and intestinal bypass.