Billing Obesity Screening, Treatment and Counseling for Medicare and Commercial Payers

Billing Obesity

If you are doing Obesity Screening and Counseling Services in your practice, here are the codes and guidelines I want to share with you:

Keyword Tag: Billing Obesity

Billing Obesity Screening, Treatment and Counseling for Medicare

Keyword Tag: Billing Obesity

HCPCS/CPT Codes

G0447 – Face-to-face behavioral counseling for obesity, 15 minutes
G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes

Keyword Tag: Billing Obesity

ICD-9-CM Codes for Obesity Screening, Treatment and Counseling for Medicare



Keyword Tag: Billing Obesity

Cross-over Diagnosis Codes (Choose 1)    –  V85.30–V85.39, V85.41–V85.45 

V85.30 Body Mass Index 30.0-30.9, adult (Use ICD-10 Code Z68.30 – Effective October 1, 2015)
V85.31 Body Mass Index 31.0-31.9, adult (Use ICD-10 Code Z68.31 – Effective October 1, 2015)
V85.32 Body Mass Index 32.0-32.9, adult (Use ICD-10 Code Z68.32- Effective October 1, 2015)
V85.33 Body Mass Index 33.0-33.9, adult (Use ICD-10 Code Z68.33 – Effective October 1, 2015)
V85.34 Body Mass Index 34.0-34.9, adult (Use ICD-10 Code Z68.34 – Effective October 1, 2015)
V85.35 Body Mass Index 35.0-35.9, adult (Use ICD-10 Code Z68.35 – Effective October 1, 2015)
V85.36 Body Mass Index 36.0-36.9, adult (Use ICD-10 Code Z68.36 – Effective October 1, 2015)
V85.37 Body Mass Index 37.0-37.9, adult (Use ICD-10 Code Z68.37 – Effective October 1, 2015)
V85.38 Body Mass Index 38.0-38.9, adult (Use ICD-10 Code Z68.38 – Effective October 1, 2015)
V85.39 Body Mass Index 39.0-39.9, adult (Use ICD-10 Code Z68.39 – Effective October 1, 2015)



Keyword Tag: Billing Obesity

V85.41 Body Mass Index 40.0-44.9, adult (Use ICD-10 Code Z68.41 – Effective October 1, 2015)
V85.42 Body Mass Index 45.0-49.9, adult (Use ICD-10 Code Z68.42 – Effective October 1, 2015)
V85.43 Body Mass Index 50.0-59.9, adult (Use ICD-10 Code Z68.43 – Effective October 1, 2015)
V85.44 Body Mass Index 60.0-69.9, adult (Use ICD-10 Code Z68.44 – Effective October 1, 2015)
V85.45 Body Mass Index 70 and over, adult (Use ICD-10 Code Z68.45 – Effective October 1, 2015)

 

billing obesity

 

Keyword Tag: Billing Obesity



Who Is Covered for Billing Obesity Screening, Treatment and Counseling for Medicare?

Keyword Tag: Billing Obesity

Medicare beneficiaries:
• With obesity (Body Mass Index [BMI] ≥ 30 kilos)
• Who are competent and alert at the time counseling is provided; and
• Whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting

  • 01 – General Practice
  • 08 – Family Practice
  • 11 – Internal Medicine
  • 16 – Obstetrics/Gynecology
  • 37 – Pediatric Medicine
  • 38 – Geriatric Medicine
  • 50 – Nurse Practitioner
  • 89 – Certified Clinical Nurse Specialist
  • 97 – Physician Assistant

Keyword Tag: Billing Obesity



Frequency for Billing Obesity Screening, Treatment and Counseling for Medicare

• First month: one visit every week;
• Months 2 – 6: one visit every other week; and
• Months 7 – 12: one visit every month if certain requirements are met At the 6-month visit, a reassessment of obesity and a determination
of the amount of weight loss must be performed.

Keyword Tag: Billing Obesity

To be eligible for additional face-to-face visits occurring once a month for an additional 6 months, beneficiaries must have lost at least 3kg.





For beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period. (Keyword Tag: Billing Obesity)

**** Approximately up to 22 visits for 12 months period.

Beneficiary Pays for Billing Obesity Screening, Treatment and Counseling for Medicare
• Copayment/coinsurance waived
• Deductible waived

Keyword Tag: Billing Obesity

Billing Obesity



 

From Medicare’s National Coverage Determination, Chapter 1, Section 210.12 – Billing Obesity Screening, Treatment and Counseling for Medicare

Keyword Tag: Billing Obesity

210.12 – Intensive Behavioral Therapy for Obesity (Effective November 29, 2011) 
(Rev. 142, issued: 02-03-12, Effective: 11-29-11, Implementation: 03-06-12)
A. General
Based upon authority to cover “additional preventive services” for Medicare beneficiaries if certain statutory requirements are met, the Centers for Medicare & Medicaid Services (CMS) initiated a new national coverage analysis on intensive behavioral therapy for obesity. Screening for obesity in adults is recommended with a grade of B by the U.S.

Keyword Tag: Billing Obesity

Preventive Services Task Force (USPSTF) and is appropriate for individuals entitled to benefits under Part A and Part B.
The Centers for Disease Control (CDC) reported that “obesity rates in the U.S. have increased dramatically over the last 30 years, and obesity is now epidemic in the United States.” In the Medicare population over 30% of men and women are obese. Obesity is directly or indirectly associated with many chronic diseases including cardiovascular disease, musculoskeletal conditions and diabetes.

Keyword Tag: Billing Obesity

B. Nationally Covered Indications (very important to take note when Billing Obesity Screening, Treatment and Counseling for Medicare Beneficiaries)
Effective for claims with dates of service on or after November 29, 2011, CMS covers intensive behavioral therapy for obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, for the prevention or early detection of illness or disability.

Keyword Tag: Billing Obesity




Intensive behavioral therapy for obesity consists of the following:
1. Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed kg/m2);
2. Dietary (nutritional) assessment; and
3. Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.




Keyword Tag: Billing Obesity

The intensive behavioral intervention for obesity should be consistent with the 5-A framework that has been highlighted by the USPSTF:

1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

Keyword Tag: Billing Obesity

For Medicare beneficiaries with obesity, who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting, CMS covers:
• One face-to-face visit every week for the first month;
• One face-to-face visit every other week for months 2-6;
• One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg weight loss requirement during the first six months as discussed below.

At the sixth month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have achieved a reduction in weight of at least 3kg over the course of the first six months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 3kg during the first six months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional six month period.



Keyword Tag: Billing Obesity

For the purposes of this decision memorandum, a primary care setting is defined as one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices are not considered primary care settings under this definition.




(This NCD last reviewed November 2011)

Keyword Tag: Billing Obesity

References: Billing Obesity Screening, Treatment and Counseling for Medicare

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8874.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part4.pdf (Section 210.12)

Keyword Tag: Billing Obesity

Billing Obesity Screening, Treatment and Counseling for Commercial Payers:

Remember that each and every payer may have different guidelines and policies on how you can properly bill Obesity Screening, Treatment and Counseling.



Billing Obesity

TOP QUESTION? – “I am NOT a Primary Care Physician or Office Setting, can I implement Obesity Screening, Counseling and Treatment Services in my Office?”

Medicare will not reimburse the NON Primary Care setting, but most commercial payers will reimburse for obesity services even for Non-Primary Care offices. Call your insurance payers and ask for your patient’s benefits and eligibility and if the insurance will cover for obesity services.

Keyword Tag: Billing Obesity

 

Here are your CPT Codes for Billing Obesity Services:

Keyword Tag: Billing Obesity

Many Physician Offices get confused with CPT Codes 99381-99397 and CPT Codes 99401-99402 when billing obesity services.

Per the CPT Code book description, it says –
“The comprehensive nature of the Preventive Medicine Services codes 99381-99397 reflects an age and gender appropriate history/exam and is NOT synonymous with the ‘comprehensive” examination required in Evaluation and Management codes 99201-99350″

“Codes 99381-99397 include couseling/anticipatory guidance/risk factor reduction interventions which are provided at the time of the INITIAL or PERIODIC comprehensive preventive medicine examination.”



…. it further reads, “REFER to codes 99401-99412 for reporting those counseling/anticipatory guidance/risk factor reduction interventions that are provided at an encounter SEPARATE from the Preventive Medicine Examination.)

Your CPT codes 99381–99397 are for comprehensive preventive evaluations. These codes are age-specific and may also be gender-specific, from birth to age 65 and over and applicable for both new and established office-based patients.




Because these are preventive services, you are required to have proper documentations for visits such as an “annual physical” include an age- and gender-appropriate history and physical examination, counseling or anticipatory guidance, and risk factor reduction interventions. CPT codes for immunizations and ancillary studies such as laboratory and radiology are reported separately. The preventive medicine comprehensive examination documentation requirements represent significant work for the physician or other provider, and payer fee schedules appropriately reflect that work.

Keyword Tag: Billing Obesity

CPT codes 99401–99409 report counseling risk factor reduction and behavioral change intervention services provided at an encounter separate from the preventive medicine examination. Individual preventive medicine counseling codes 99401–99404 are used to report counseling services in areas such as family problems, diet, and exercise.

Keyword Tag: Billing Obesity

Per the many payers that I have seen when billing obesity services, use CPT Codes 99401-99402 for the services rendered on your patients:

CPT 99401, which covers a 15-minute
CPT 99402, which denotes 30 minutes.

Keyword Tag: Billing Obesity

Reimbursement and Fees: Billing Obesity Services

For Medicare HCPCS/CPT Code – G0447  National Allowed Amount is about $25.00

99401-99402 is about the same amount

Keyword Tag: Billing Obesity

Some Commercial Payer’s Guidelines for Billing Obesity:

Keyword Tag: Billing Obesity

United Healthcare:
Screening for Obesity in Adults USPSTF Rating (June 2012): B
The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions.




Procedure Code(s):
Medical Nutrition Therapy: (Nutritionist and Dieticians)
• 97802, 97803, 97804
Preventive Medicine Individual Counseling: (Physicians and other Health Providers)
• 99401, 99402, 99403, 99404
Behavioral Counseling or Therapy: (Medicare)
• G0447, G0473 (2-10 in a group)

Keyword Tag: Billing Obesity

Diagnosis Code(s): Body Mass Index 30.0 – 39.9:
• ICD-9: V85.30, V85.31, V85.32, V85.33, V85.34, V85.35, V85.36, V85.37, V85.38, V85.39
• ICD-10: Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39
Body Mass Index 40.0 and over:
• ICD-9: V85.41, V85.42, V85.43,

Keyword Tag: Billing Obesity




Reference Guideline Read it here (Copy and Paste the URL on your Browser) https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Preventive_Care_Services_CD.pdf

Keyword Tag: Billing Obesity

Let’s wrap this up — for your Billing Obesity Screening and Treatment Services in the Office:

Use Code G0447 for your Medicare Patients Part B Claims

Use Code 99401-99402  for your Commercial Insurance Payers

**** ICD-9 Cross Overs (see above)

 

STILL CONFUSED for Billing Obesity Services?

Obesity services for your practice can become a good source of additional revenue to grow your practice. And we all know that Medicare and all other commercial payers are covering these services. So why not implement it in your practice? Should you need help, please connect with me and I am here to help you.

I hope this blog post brought value for your practice.

Keyword Tag: Billing Obesity

Connect with us, we will show you HOW TO IMPLEMENT OBESITY SCREENING, TREATMENT AND COUNSELING SERVICES IN YOUR PRACTICE TODAY! 

 

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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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