Does Medicare cover obesity counseling?

What does Medicare cover for obesity counseling?

Medicare Part B covers obesity behavioral therapy as a preventive service. The therapy includes an initial screening for body mass index (BMI) and behavioral therapy sessions with a dietary assessment and counseling to help you lose weight by focusing on diet and exercise. You must meet certain weight loss requirements for Medicare to keep covering the counseling.

Who qualifies, and who can provide the counseling?

You qualify if your BMI is 30 or more. Under CMS's national coverage determination, you must also be competent and alert when the counseling is given, and the counseling must come from a qualified primary care doctor or other primary care practitioner in a primary care setting, where your provider can coordinate your personalized prevention plan with your other care.

CMS counts these as primary care providers:

• Doctors identified as general practitioners, family practice practitioners, general internists, or obstetricians or gynecologists
• Doctors whose primary specialty is family medicine, internal medicine, geriatric medicine or pediatric medicine
• Nurse practitioners, clinical nurse specialists and physician assistants

How often does Medicare cover obesity counseling visits?

Medicare covers up to one face-to-face visit a week at the start, with fewer visits later in the year:

• One face-to-face visit every week for the first month.
• One face-to-face visit every other week for months 2 through 6.
• One face-to-face visit every month for months 7 through 12, if you lost at least 3 kilograms during the first 6 months.
• At the 6-month visit, your provider reassesses your obesity and records how much weight you've lost. If you haven't lost at least 3 kilograms, CMS says a reassessment of your readiness to change and your BMI is appropriate after another 6 months.

What do I pay for obesity counseling with Medicare?

You pay nothing for obesity behavioral therapy if your primary care provider accepts assignment. CMS's coverage determination says the Part B coinsurance and the Part B deductible are waived for this service, so the $283 Part B deductible in 2026 doesn't apply.

Where isn't Medicare obesity counseling covered?

Medicare covers obesity counseling only in a primary care setting. CMS says these places aren't primary care settings for this benefit:

• Emergency departments
• Inpatient hospital settings
• Ambulatory surgical centers
• Independent diagnostic testing facilities
• Skilled nursing facilities
• Inpatient rehabilitation facilities and hospices

Does Medicare Advantage cover obesity counseling, and what about weight-loss drugs?

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and some offer extra benefits; rules and costs vary by plan. Separately, the temporary Medicare GLP-1 Bridge covers certain GLP-1 drugs for people who have Medicare drug coverage (Part D), aren't already getting these drugs covered by Part D, and meet other requirements, for a $50 copayment for a one-month supply; see Does Medicare cover weight-loss drugs like Wegovy and Zepbound?. For surgery, see Does Medicare cover bariatric surgery?.