Wiki Horizon BCBS denying 99402

[Biller2023]

Why does Horizon BCBS deny claims submitted with 99402 Diagnosis Z71.3 stating "This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement"

What are the CPTs that we can use to bill Horizon for weight management or dietary counselling

 

[Biller2023]

Can someone please respond to this?

 

[sls314]

What else is being billed on the claim? Any other CPT codes or diagnosis codes?

Remember that the ACA preventive care mandates specify "Diet counseling, for adults at higher risk for chronic disease." It doesn't necessarily mean that everyone will have coverage for dietary counseling - that will depend on the plan's benefits. (You can see the list of preventive services under the ACA here: https://www.healthcare.gov/coverage/preventive-care-benefits/ )

Z71.3 has some "Use additional code..." notes. If this information was documented appropriately, were those ICD-10 codes billed as well?




Also, if a preventive office was billed on the same DOS, many payers will consider the counseling to be part of the preventive office visit and not reimburse separately for 99402. (In fact, the CPT description for 99402 even includes the phrase "separate procedure.")

diagnosis codes, diagnosis coding