10/05/2026
We have been receiving a lot of questions regarding weight loss services and RHCs, so we wanted to share some helpful information to clarify Medicare coverage, counseling requirements, and billing.
Medicare covers Wegovy and obesity counseling through two separate benefits, which are often utilized together but governed by different parts of Medicare.
Medicare will pay 22 visits per year for intensive behavioral therapy (obesity counseling) under Part B. This is not a restriction on how often patients can get their medication. These 22 visits can be billed on a UB04 as a RHC encounter. These are stand alone encounters, just like annual wellness visits. If they are billed with another RHC encounter, only one AIR will be paid.
Intensive Behavioral Therapy for Obesity G0447 Behavior counsel obesity 15 min.
https://www.cms.gov/medicare/prevention/prevntiongeninfo/medicare-preventive-services/mps-quickreferencechart-1.html
1. Medicare Part B: Obesity Counseling (22 Sessions)
Medicare Part B covers up to 22 face-to-face behavioral therapy sessions in a 12-month period at no cost ($0 copay) if you have a Body Mass Index (BMI) of 30 or higher.
Months 1: 1 session per week (4 sessions total).
Months 2–6: 1 session every other week (10 sessions total).
Months 7–12: 1 session per month (6 sessions total). Note: To qualify for the final 6 months, you must lose at least 6.6 pounds (3 kg) during a 6-month check-in.
Provider Requirement: These sessions must be provided by a primary care practitioner in a primary care setting.
2. Medicare Part D: Wegovy Coverage Rules
While Medicare is historically barred from covering medications strictly for weight loss, coverage for Wegovy is currently available through two specific pathways:
Medicare GLP-1 Bridge Program: A temporary CMS initiative running through December 31, 2027 allows eligible Part D enrollees meeting specific BMI tiers and health risks to get Wegovy for a flat $50 monthly copay.
Cardiovascular Risk Reduction: Standard Medicare Part D plans cover Wegovy if you are overweight or obese and have a documented history of established heart disease (prescribed to reduce the risk of heart attacks and strokes).
Participating in the 22 counseling sessions is not a strict prerequisite to receive Wegovy. However, to qualify for the medication, your prescribing doctor must attest that you are actively engaging in a reduced-calorie diet and increased physical activity plan. Many physicians utilize the 22 covered behavioral therapy sessions as a way to fulfill this clinical lifestyle requirement.
Preventive Services Chart. Learn about codes; who is covered; frequency; and what the Medicare patient pays.
