Navigating Reimbursement

Reimbursement for treating obesity as a standalone diagnosis can be challenging. However, many individuals with obesity have related comorbid conditions, and care addressing most of those conditions is reimbursable.


Reimbursement Opportunities

When addressed as one of the contributing factors to hypertension, diabetes, kidney and liver disease, lipid disorders, and other chronic conditions discussed in Step 1 (Kickstart) of this toolkit, primary care providers can obtain compensation for services. Other providers, including dietitians who can assess diets and prescribe interventions, physical therapists and exercise coaches with specialized knowledge of the older adult, endocrinologists for patients with underlying metabolic or hormonal disorders, and surgeons when bariatric surgery is needed, may also be involved in the care of patients with overweight and obesity and be able to obtain compensation in specific circumstances.

Medicare-covered Care

Within the Medicare population, reimbursements are available for intensive behavioral therapy and nutritional counseling provided by primary care physicians and for bariatric surgery. As discussed later in Step 3 (Evaluate), many other effective interventions are available for managing overweight and obesity between these extremes of a stepped-care approach.

Guidance on Documentation and Billing Codes

In addition to billing for conditions related to obesity and overweight, providers can seek guidance on documentation and billing codes at RethinkObesity.com. The Obesity Medicine Association’s Academy has educational programs on billing and coding; visit the page and search for “billing.” The Alliance for Women’s Health and Prevention’s EveryBODY Covered campaign offers resources aimed at helping to ensure that everybody has access to evidence-based obesity care options, including a helpful patient education resource titled Navigating Obesity Care Coverage Denials.