Under the Patient Protection and Affordable Care Act (PPACA), coverage is provided for many preventive services without cost share (copayments, deductibles and coinsurance) to patients if provided by in-network providers.
A reminder that the following are covered as preventive services for Medicare Advantage Plans and Commercial Products:
- Behavioral counseling for obesity, provided by a qualified primary care provider, for adults with a BMI of 30 or higher
- Coverage is based on the time-based HCPCS Level ll G codes when providing time-based evaluation and management (E/M) counseling services related to obesity.
- Nutrition counseling provided by a licensed, in-network dietitian or qualified provider
- Commercial Plans: For adults with chronic disease and/or cardiovascular disease risk factors, no frequency limits.
- Medicare Advantage Plans: Nutrition counseling is for people with diabetes, renal disease (but not on dialysis) or after a kidney transplant.
- Three hours is covered during the first year under Medicare, and two hours each year after that. Note that physicians can order additional hours beyond the initial coverage if a change in a medical condition requires a change in diet.
For additional details, please see related policies and billing codes below: