Intensive Behavioral Therapy for Obesity

CMS covers intensive behavioral therapy for obesity for Medicare beneficiaries with BMI ≥ 30 kg/m2, including BMI screening, dietary assessment, and intensive counseling consistent with the USPSTF 5-A framework when furnished by a qualified primary care physician/practitioner in a primary care setting and when the beneficiary is competent and alert. Covered visit frequency is weekly in month 1, biweekly in months 2–6, and monthly in months 7–12 only if the beneficiary has lost at least 3 kg during the first six months; required documentation includes BMI calculation and recorded weight-loss at six months. Services provided outside the defined provider types or primary care settings, for beneficiaries with BMI < 30 kg/m2, or for other non-specified indications are not covered.

"Medicare beneficiaries with body mass index (BMI) greater than or equal to 30 kg/m2 are eligible for intensive behavioral therapy for obesity for prevention or early detection of illness or disabil..."