`G0473` Group behave couns 2-10

Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 1 units per day (clinical), rationale: Clinical: Data

Medicare pricing for G0473

Physician Fee Schedule (CY 2026, RVU26D)

Status A: active, paid separately under the PFS if covered. National amounts: non-facility $12.69, facility $10.02 (total RVUs 0.38 / 0.30 × $33.4009 conversion factor). Work RVU 0.23, practice expense RVU 0.14 non-facility and 0.06 facility, malpractice RVU 0.01. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.

Payer policies and prior authorization for G0473

Payer coverage policies that name G0473

G0473 appears in 2 coverage policies from Aetna, Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Nutritional Counseling (0049)	covered if criteria are met	Mar 10, 2026	payer document
Premera Blue Cross	Preventive Care Obesity screening and counseling	covered if criteria are met	Sep 21, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

ND: $0.00 (physician), effective Aug 1, 2026
VT: $29.09 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $16.57 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

G0473 Group behave couns 2-10