How to Get Paid for Obesity Services

According to the Centers for Disease Control and Prevention
“Obesity, a common and costly health issue, affects more than one-third of adults and 17 percent of youth in the United States. “
By the numbers, 78 million adults and 12 million children are obese—figures many regard as an epidemic.

​Being obese increases the risk for heart disease, stroke and type 2 diabetes—the first, fourth and seventh leading causes of death, respectively—and contributes to more than one in five cancer-related deaths. Obesity-related health care spending continues to grow, with researchers estimating medical costs at $147 billion annually, including $7 billion for Medicare prescription drugs.

The American Medical Association recognized obesity as a disease in 2013 and the American Academy of Pediatrics recommended obesity prevention, assessment and patient counseling in 2007.

Medicare first recognized obesity as a medical condition in 2004 and began covering interventions when scientific evidence demonstrated their effectiveness.
In 2011, Medicare issued a Coverage Decision memorandum outlining requirements for intensive behavioral counseling and therapy for beneficiaries affected by obesity.

As of January 2012, Medicare and most private insurers cover obesity screening and behavioral counseling. In addition, as of Jan.1, 2014, the ACA requires: No consumer cost- sharing. Most insurance plans in all 50 states are required to cover certain services with no cost-sharing, including obesity screening and counseling for all adults and children. This includes no annual deductible amount, no enrollee copayments or coinsurance. Premium surcharges for being obese are prohibited in most insurance policies in all 50 states, including those sold through exchanges.
Source: http://www.ncsl.org/research/health/aca-and-health-mandates-for-obesity.aspx
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Medicare Guideline and Policy:

Make sure that …

• Your specialty is eligible for Obesity Services (Prevention, Treatment, Counseling and/or Coordination of Care)
• Your specialty is properly listed with your contracted payers
• You have to do your patient’s insurance verification for benefits and eligibility – specifically for Obesity Services.

Eligible Specialties:

• General Practice
• Family Practice
• Internal Medicine
• Obstetrics/Gynecology
• Pediatric Medicine
• Geriatric Medicine
• Nurse Practitioner
• Certified Clinical Nurse Specialist
• Physician Assistant

Geriatric Medicine
Nurse Practitioner
Certified Clinical Nurse Specialist
Physician Assistant