Friday, April 22, 2016

Reimbursement for Obesity Treatment

In the past, one of the problems with adding obesity medicine to a primary care practice was reimbursement for the obesity services from third party payers. Of course, getting paid is less of a problem for those obesity medicine physicians who use a cash-based payment system. However, for those providers desiring insurance reimbursement, there was no way to get paid via insurance for obesity treatment until the passage of the Affordable Care Act (ACA) in 2010.

Before the ACA, to get paid, practitioners had to code for conditions associated with obesity rather than obesity, even though many of the conditions were thought to be caused by obesity. So the providers would treat and code for type 2 diabetes, sleep apnea, heart disease and other obesity related ailments. With the passage of ACA, CPT and ICD codes were designated that can be used by providers to get third party reimbursement for obesity treatment. And ACA directs insurance companies to pay for the obesity treatment (in the form of obesity counseling) without requiring any copay or coinsurance from the covered patients.

CPT codes that can be used for obesity counseling are codes 99401-99404 for commercial payers and G0447 for Medicare. The obesity ICD-9 codes are V85.30-V85.39, V85.41-V85.45 (Of course, appropriate ICD-10 codes should now be used).

Further, Medicare specified the healthcare providers that Medicare will reimburse for obesity treatment. The providers must be in one of the following specialties: General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine or Geriatric Medicine. A Nurse Practitioner, Certified Clinical Nurse Specialist or Physician Assistant can also do the counseling. While this kind of provider specificity was not indicated for commercial insurers, most commercial insurers will likely use guidelines similar to the Medicare guidelines for reimbursement.

Finally, according to a speaker at the American Society of Bariatric Physicians (ASBP) conference in 2015, no guidance is given as to what obesity counseling should entail. The speaker, however, alluded to a suggestion that the USPSTF (United States Preventative Services Task Force) recommendations be followed. These recommendations are as follows:  Employ "behavioral management activities, such as setting weight-loss goals, improving diet or nutrition and increasing physical activity, addressing barriers to change, self-monitoring, [and] strategizing how to maintain lifestyle changes."

At any rate, it is now possible for obesity medicine providers to get reimbursed for obesity treatment. So, it is now more feasible than in the past for a primary care physician to include obesity treatment in his or her primary care practice, if he or she so desires. 


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