Body mass index (BMI) is a measure of body fat in adults. BMI screenings and follow-up behavioral counseling can help you lose weight if your BMI is high.
Medicare Part B covers BMI screenings and behavioral counseling to help you lose weight if you are obese. You are obese if you have a BMI of 30 or higher.
Once your doctor diagnoses you as obese, you can qualify for behavioral counseling and therapy to help you lose weight and sustain weight loss through proper diet and exercise. Medicare covers a series of visits for behavioral counseling:
- One face-to-face visit every week for the first month
- One face-to-face visit every other week during months 2-6
- One face-to-face visit every month during months 7-12 if you lose 6.6 lbs within the first six months*
*After your first six months of therapy, you will be re-screened for obesity. During this re-screening, your doctor will determine how much weight you have lost since your initial screening. To be eligible for additional face-to-face visits with your doctor during months 7-12 of behavioral therapy, you must lose at least 6.6 lbs (3 kg) during the first six months of therapy. If you do not lose at least 6.6 lbs during the first six months of behavioral visits, your therapy may end. Your doctor can reassess you for another Medicare-covered obesity screening after six months have passed.
If you qualify, Original Medicare covers BMI screenings and behavioral counseling at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover BMI screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
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