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Medicare pays for some weight loss treatments related to obesity, including counseling and certain surgeries. However, it does not usually cover weight loss programs for general health.
Medications like Wegovy are known as GLP-1 agonists, and many of these drugs were initially prescribed to help manage Type 2 diabetes but have since gained popularity to help patients manage weight.
Last year, Medicare reached agreements to lower prices on 10 drugs. The program is supposed to release a list of 15 more prescription drugs selected for the next round of negotiations by Feb. 1.
HCPCS includes three levels of codes: Level I consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric.; Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices, and represent items and supplies and non-physician services, not covered by CPT-4 codes (Level I).
Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming. Weight loss is the main treatment for obesity, [1] [2] [3] and there is substantial evidence this can prevent progression from prediabetes to type 2 diabetes with a 7–10% weight loss and manage cardiometabolic health for diabetic people with a ...
For every patient encounter, providers must record both ICD codes to identify the diagnosis and CPT codes to document the treatment. Given the vast number of codes—approximately 70,000 for ICD and over 10,000 for CPT—using advanced medical billing software is recommended to streamline the coding process, reduce errors, and ensure compliance ...
The 15 drugs accounted for $41 billion, or 14%, of total Medicare Part D spending between Nov. 1, 2023, and Oct. 1, 2024.
For more than two decades, a law has prohibited Medicare from paying for weight loss drugs, cutting off access to millions of potential patients who could stand to benefit.