CPT and HCPCS Codes for Obesity Counseling: G0447, G0473 and E/M

Obesity counseling is billed one of three ways: Medicare's intensive behavioral therapy codes G0447 (individual, 15 minutes) and G0473 (group of 2 to 10, 30 minutes), preventive counseling codes 99401 to 99404 for plans that cover them, or an E/M visit when counseling is part of managing the condition. Ona carries the code from the service onto the claim.

Quick answer:

• G0447 and G0473 are Medicare codes for intensive behavioral therapy for obesity under NCD 210.12. They need a BMI of 30 or more, a primary care practitioner in a primary care setting, and an adult BMI code from Z68.30 to Z68.45 on the claim line. Medicare waives coinsurance and the Part B deductible.
• Medicare allows up to 22 sessions of G0447 and G0473 combined in a 12-month period, on a fixed schedule, with a 3 kg weight-loss check at six months.
• For medical weight management visits, including GLP-1 follow-ups, an office E/M code chosen by medical decision making or total time on the date of the visit is the usual route. Both G0447 and G0473 are on the CY 2026 Medicare telehealth list.

Three Ways to Bill Weight Counseling

The code depends less on what was said in the room than on who said it, who is paying, and what else happened at the visit.

Code	What it covers (paraphrased)	Main payer use	Key rule
G0447	Face-to-face behavioral counseling for obesity, 15 minutes	Medicare	NCD 210.12 criteria, Z68.30 to Z68.45 on the line, eligible specialty and place of service
G0473	Face-to-face behavioral counseling for obesity, group of 2 to 10, 30 minutes	Medicare	Same criteria; counts toward the same 22-session limit
99401 to 99404	Individual preventive counseling and risk-factor reduction, in time-based steps	Commercial plans that cover them	Coverage varies by plan and is often limited to obesity diagnoses
99202 to 99205	New-patient office or outpatient visit, leveled by decision making or total time	All payers	Use when counseling is part of evaluating and managing the condition
99212 to 99215	Established-patient office or outpatient visit, leveled the same way	All payers	The usual code for medical weight management follow-ups
G2211	Medicare add-on for the complexity of a longitudinal care relationship	Medicare	Reported with an office E/M base code, not payable when the base code carries modifier 25

CPT code descriptors are copyrighted by the AMA, so the table paraphrases them. The G0447 and G0473 descriptors are CMS HCPCS text.

Medicare Intensive Behavioral Therapy for Obesity: G0447 and G0473

Medicare has covered intensive behavioral therapy for obesity since November 29, 2011. The coverage rules sit in the National Coverage Determination for Intensive Behavioral Therapy for Obesity (210.12), and the billing rules in the Medicare Claims Processing Manual, Chapter 18, section 200.

Who qualifies

Per CMS, the benefit covers beneficiaries with obesity, defined as a BMI of 30 kg/m2 or more, who are competent and alert at the time of counseling, when counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting. The NCD excludes emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices.

The visit schedule

CMS sets the schedule out in three phases:

• One face-to-face visit every week for the first month.
• One face-to-face visit every other week for months 2 to 6.
• One face-to-face visit every month for months 7 to 12, but only if the beneficiary has lost at least 3 kg (6.6 lbs) during the first six months.

At the six-month visit, obesity is reassessed and weight loss determined. A beneficiary who has not met the 3 kg threshold gets a reassessment of readiness to change and BMI after a further six months. Effective for dates of service from January 1, 2015, G0447 and G0473 together can be billed for no more than 22 sessions in a 12-month period. Medicare denies sessions beyond that with a benefit-maximum adjustment reason.

What the counseling has to contain

The manual says sessions follow the 5As approach adopted by the USPSTF: assess, advise, agree, assist and arrange. In documentation terms, the note for each session should show the assessment of risk and readiness, the specific advice given, the goals agreed with the patient, the help provided toward those goals, and the follow-up arranged. Session length belongs in the note too, because G0447 is a 15-minute code and G0473 a 30-minute group code.

Claim requirements that cause denials

The manual lists the edits, and each one is a denial reason if missed:

• Diagnosis. Each G0447 or G0473 line needs an adult BMI code from Z68.30 to Z68.39 or Z68.41 to Z68.45. Lines without one are denied as a non-covered diagnosis. Code the obesity diagnosis too, for example E66.811 or E66.812.
• Provider specialty. Professional claims are allowed only from these specialties on the enrollment record: general practice, family practice, internal medicine, obstetrics/gynecology, pediatric medicine, geriatric medicine, nurse practitioner, certified clinical nurse specialist and physician assistant.
• Place of service. Professional claims are allowed with POS 11 (physician's office), 19 (off-campus outpatient hospital), 22 (on-campus outpatient hospital), 49 (independent clinic) and 71 (state or local public health clinic).
• Frequency. No more than 22 sessions of the two codes combined in 12 months.

On cost sharing, CMS lists intensive behavioral therapy for obesity among the preventive services with coinsurance and deductible waived, in its Chapter 18 section 1.2 table.

What this means for specialty weight clinics

The specialty list is the edit that catches stand-alone obesity medicine practices. If the billing clinician is enrolled with Medicare under a specialty that is not on the list, G0447 claims deny regardless of how good the documentation is. That is a credentialing question to settle before you build a Medicare IBT program, not after the first remittance.

Preventive Counseling: 99401 to 99404

Codes 99401 to 99404 are time-based preventive medicine counseling codes for risk-factor reduction delivered to an individual. They are mostly a commercial-payer conversation. The AAFP's July 2026 FPM coding column says it is appropriate to report them for lifestyle counseling visits that address risk-factor reduction in patients with overweight, but that payment varies by plan, and that policies limiting coverage to specific diagnoses often include only obesity (BMI of 30 or more, Z68.30 to Z68.45).

The same column makes a point that saves claims: if overweight is addressed during a visit for a related condition, the counseling time counts toward the E/M visit for that condition, and the counseling is not reported separately. Check each payer's policy before building 99401 to 99404 into a fee schedule.

E/M Visits for Medical Weight Management

Most physician-led and NP-led weight programs, including GLP-1 programs, bill their visits as office E/M services, because the visit is medical management: reviewing history and results, making a prescribing decision, ordering labs, managing related conditions. Per the CMS Evaluation and Management Services guide (MLN006764, May 2026), office and outpatient E/M levels are selected using either medical decision making or total time on the date of the encounter, and the note should support whichever you used.

For Medicare patients, G2211 can be added to an office E/M code when the visit is part of an ongoing relationship where the practitioner is the continuing focal point for care or manages a single serious or complex condition over time. CMS does not pay G2211 when the base E/M code is reported with modifier 25, except when the same practitioner reports it on the same day as an annual wellness visit, vaccine administration or any Medicare Part B preventive service. Intensive behavioral therapy for obesity appears in CMS's own Chapter 18 table of preventive services, so a same-day E/M with modifier 25 and G0447 falls under that exception. Document why the visit was billed, because CMS says the documentation needs to show the medical necessity of the visit.

Can G0447 go on the same day as an E/M visit? It is a separate service, so the counseling time must be distinct from the E/M work and documented separately. Payers apply their own same-day rules, so confirm with your Medicare Administrative Contractor or the plan before billing both together routinely.

Telehealth Rules for Obesity Counseling

G0447 is on the CY 2026 List of Medicare Telehealth Services, and G0473 was added for 2026. Office E/M codes such as 99202 to 99205 and 99212 to 99215 are on the list too.

The CMS telehealth FAQ, updated October 2026, sets out the current position:

• Through December 31, 2027, Medicare beneficiaries can receive telehealth services anywhere in the United States, including at home. From January 1, 2028, outside behavioral health, beneficiaries will generally need to be in a medical facility in a rural area.
• Practitioners use POS 02 for telehealth provided somewhere other than the patient's home and POS 10 for telehealth provided in the patient's home. Home telehealth is paid at the non-facility rate.
• From January 1, 2027, CMS requires two new telehealth modifiers where they apply: BB, for services furnished through a virtual platform owned by an entity the practitioner contracts or has a payment arrangement with, and BC, for telehealth services furnished incident to a practitioner's service. CMS says neither has payment implications.

One wrinkle for G0447: the Chapter 18 place-of-service edit lists in-person POS codes, while the telehealth FAQ points practitioners to POS 02 and 10. Confirm with your MAC how it applies the edit to telehealth G0447 claims before you scale a virtual IBT program. Commercial plans set their own telehealth modifier and POS rules, and some still ask for modifier 95.

How Obesity Counseling Codes Flow Through Ona

Ona builds the claim from the visit, so the codes are set up once and reused:

1. Services carry billing defaults. Each service, such as "Obesity counseling, individual" or "Weight management follow-up", carries its CPT or HCPCS code, place of service, modifiers, benefit types and default copay, per Setting up services. A telehealth version of the service can carry its own place-of-service code, and Ona defaults video visits to POS 10. See telehealth.
2. The fee schedule prices the code. Global rates, payer-specific rates and separate self-pay cash rates are set per CPT code in Settings, and a spreadsheet import updates global rates in bulk.
3. Diagnoses come from the chart. The E66 and Z68 codes charted on the visit flow into the draft claim, which rebuilds as the chart changes. Billing rules can check that every line carries a diagnosis, and payer overrides or custom rules can block, warn or move a claim to a work bucket. See insurance and claims.
4. Eligibility first. Coverage is checked when the patient books and again in the 48 hours before the visit, so a non-covered counseling benefit shows up before the session, not on the remittance.
5. Self-pay and superbills. For cash-pay patients, the visit's invoice is drafted from its services, and a completed visit can produce a superbill with CPT codes and fees for the patient to submit, as described in From visit billing to superbill and claim. Payments run on your own Stripe account through billing.
6. Submission and ERAs. Claims go through Ona Clearing House, from $69 per month for 100 claims, 100 ERAs and 200 eligibility checks, or your own Claim.MD account, and remittances post back to the claim and the patient's invoice.

This coding guidance is general. Payer rules vary, so confirm coverage, frequency and modifier requirements with the payer before you bill.

Frequently asked questions

What is CPT code G0447?

G0447 is a HCPCS code, not a CPT code: face-to-face behavioral counseling for obesity, 15 minutes. Medicare covers it under NCD 210.12 for beneficiaries with a BMI of 30 or more when a primary care practitioner provides it in a primary care setting. Each claim line needs an adult BMI code from Z68.30 to Z68.39 or Z68.41 to Z68.45.

What is the difference between G0447 and G0473?

G0447 is individual obesity counseling in a 15-minute unit. G0473 is face-to-face behavioral counseling for obesity in a group of 2 to 10 patients, 30 minutes. Both follow the same Medicare coverage rules, and together they are limited to 22 sessions in a 12-month period, per the CMS Medicare Claims Processing Manual.

How many G0447 sessions does Medicare cover?

Up to 22 sessions of G0447 and G0473 combined in 12 months. The schedule is weekly in month one, every other week in months 2 to 6, and monthly in months 7 to 12 only if the patient lost at least 3 kg in the first six months. Medicare waives coinsurance and the Part B deductible for this benefit.

Who can bill G0447?

Medicare allows professional G0447 claims only from general practice, family practice, internal medicine, obstetrics/gynecology, pediatric medicine, geriatric medicine, nurse practitioners, certified clinical nurse specialists and physician assistants, with place of service 11, 19, 22, 49 or 71. Claims from other specialties are denied, per the CMS Medicare Claims Processing Manual.

What CPT code do I use for weight loss counseling with commercial insurance?

Many commercial plans recognize the preventive counseling codes 99401 to 99404, but coverage varies, and policies often limit them to obesity diagnoses with a BMI of 30 or more. When counseling happens during a visit to manage a condition, the time usually counts toward an office E/M code instead. Check each plan's policy first.

Can obesity counseling be billed as telehealth?

For Medicare, yes for now. G0447 and G0473 are on the CY 2026 Medicare telehealth list, and per the CMS telehealth FAQ, patients can receive telehealth at home through December 31, 2027. Use POS 10 for the patient's home or POS 02 elsewhere, and confirm with your MAC how it applies the G0447 place-of-service edit.

Next step

If your weight program bills a mix of Medicare counseling, E/M follow-ups and self-pay visits, the useful test is whether one service setup produces the right claim for each. Bring your code list to a 15-minute demo, or check clearing house tiers on the pricing page and start the 14-day free trial.