Wiki Obesity Counseling (NON Medicare)

[suemt]

Does anyone besides Medicare pay for obesity counseling? If so, is billing done with the 994xx series, or are payors using the G0447 code?

Sue

 

[squeaker7]

Blue Cross

I found the following information for Blue Cross, but have not been able to locate anything for Medicaid and others.

97802: initial assessment face to face with patient, 15mins; unit limit 10
97803: reassessment and intervention, 15mins; unit limit 10

It also states that coverage depends on individual's plan of course. Hope this helps. We've billed out a couple, but haven't received anything back yet.

 

[suemt]

What I'm finding is so confusing! It looks like some payors want you to use regular E/M codes, some want you to use the preventative E/M codes, and then others want the Medical Nutrition Therapy codes used.

When I see stuff that is this confusing, I will bet big bucks that if I call the payor I won't get the same answer twice.

Anyone know a way to find out without playing the bill/deny/rebill game?

 

[CBLENNIE]

I work for a payer setting up our ajudication platform with the plan benefits for a our employer sponsored self funded plans and if the client is non-grandfathered for ACA we have to cover obesity counseling as a mandated preventive service starting at age 6 years.

We are having some difficulting in identifying these services but we would pay claims with the procedure codes you asked about if billed by an appropriate provider with the proper diagnosis linked to the specific procedure code. We have issues with the providers billing all of the services on a a claim as linked to diagnosis 1, 2, 3 & 4 and if diagnosis #1 isn't an obesity or morbid obesity diagnosis we aren't going to cover these services according to the ACA mandates.

I understand your frustration about not getting information on how to properly bill these services for each individual payer but in our situation we don't maintain PPO contracts with providers, our clients pay for access to various PPO networks and therefore we as a TPA cannot tell providers to bill. So if you are contacting a TPA that you aren't contracted with directly as a network provider you are likely going to be told that they can't provide you with instructions on how to bill the service to be paid properly.

 

[suemt]

Thank you for the feedback on the diagnosis code linking! I have seen that many practices either don't understand how to use these codes or they figure they are covering all the bases by doing the 1,2,3,4.

I welcome any other feedback on how to determine how to receive payment for these services from non-Medicare payors.