"CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.""

Coding Guidelines for CPT G0447 & G0442


Coding Guidelines  for Screening  and counseling  services

Medicare:

Medicare does not allow the billing of other services performed on the same day as an obesity counseling visit.

Screening Services Codes:

G0101, G0102, Q0091, G0442, G0444

Reimbursement Guidelines:

The comprehensive nature of a preventive medicine code reflects an age and gender appropriate examination. When a "Screening code is billed with a preventive medicine code" on the same date of service by the Same Specialty Physician or Other Health Care Professional, "only the preventive medicine code is reimbursed".

Obesity counseling is not separately payable with another encounter/visit on the same day. For services that contain HCPCS code G0447 with another encounter/visit with the same date of service, the service line with HCPCS G0447 will be denied.

This intensive behavioral therapy service is considered to be included in the payment/allowance of other encounter services provided on the same date of service

This does not apply for Initial Preventative Physical Examination (IPPE) claims, claims containing modifier 25 indicating a significant and separate E/M service as distinct from the obesity counseling

For eligible adult health plan members with obesity, defined as Body Mass Index (BMI) equal to or greater than 30 kg/m2, optum will align reimbursement with Medicare including:
  • One face-to-face visit every week for the first month;
  • One face-to-face visit every other week for months 2-6; and
  • One face-to-face visit every month for months 7-12 [if the member meets the 3kg (6.6 lbs.) weight loss requirement during the first 6 months.]
For adult members who do not achieve a weight loss of at least 3 kg (6.6 pounds) during the first 6 months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

These visits must be provided by a qualified health care provider.

For eligible children and adolescent (6-18 years) health plan members with overweight, defined as having an age/gender-specific BMI at or above the 85th percentile, Optum will align reimbursement with the recommendations of the U.S. Preventive Services Task Force.

CPT codes for obesity screening and counseling are:
  • 99401 Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes
  • 99402 Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes
HCPCS codes related to obesity screening and counseling are:
  • G0446 Annual, face-to-face intensive behavioral counseling (IBT) for cardio-vascular disease (CVD), individual, 15 minutes
  • G0447 Face-to-face behavioral counseling for obesity, 15 minutes
  • G0473 Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes.
Counseling Services Codes:

0403T, 99401, 99402, 99403, 99404, 99406, 99407, 99408, 99409, 99411, 99412, G0296, G0396, G0397, G0443, G0445, G0446, G0447, G0473, H0005, S0257, S0265, S9470, T1006, T1027

Reimbursement Guidelines:

Preventive Medicine Services include counseling. When counseling service codes are billed with a preventive medicine code on the same date of service by the Same Specialty Physician or Other Health Care Professional, only the preventive medicine code is reimbursed.

Reference: 

1. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Preventive-Medicine-and-Screening-Policy.pdf
2. https://www.ethicon.com/na/system/files/2018-03/087494-180207_2018_Obesity_Rmbrsmnt_Fact_Sheet_r8%20%281%29.pdf
3. https://www.myoptumhealthphysicalhealth.com/Documents/Reimbursement%20Policies/0064_ObesityScreeningandCounselingReimbursementPolicy.pdf


Blogger Widget

Popular Posts