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Forum Discussion Areas > Ask Us a Question > Modifier to use for G0447 when billing with E/M 99201-99215 to UHC
  Modifier to use for G0447 when billing with E/M 99201-99215 to UHC
aretalex1
Modifier to use for G0447 when billing with E/M 99201-99215 to UHC
Posted:
Mar 16 2013, 10:41 AM
UHC bundles G0447 with E/M code even though E/M code has modifier 25. Every other insurance pays for G0447 and E/M code when E/M has modifier 25 but UHC representative told me they are looking for modifier with G0447 to unbundle it from E/M code. Of course, the representative would not tell me what modifier needs to be used. I have tried adding 25 and 59 to G0447 but still getting this code bundled with E/M. Does anyone know what modifier UHC is looking for? This problem happens only with UHC.

 
nmaguire
re: Modifier to use for G0447 when billing with E/M 99201-99215 to UHC
Posted:
Mar 16 2013, 11:13 AM
Screening forObesity in Adults No mention of modifier TheUSPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventionsto promote sustained weight loss for obese adults. Procedure Code(s): Medical Nutrition Therapy: 97802, 97803, 97804 Preventive Medicine Individual Counseling:99401, 99402, 99403, 99404 Behavioral Counseling or Therapy: G0446,G0447 Diagnosis Code(s):Body MassIndex 40.0 and over:V85.41, V85.42, V85.43, V85.44, V85.45 Obesity:278.00, 278.01. These codes may be subject to our Reimbursement Policies and may not be payable when billed in addition to another code or service. G0446 is limited to once per year. 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

 
aretalex1
re: Modifier to use for G0447 when billing with E/M 99201-99215 to UHC
Posted:
Mar 24 2013, 5:19 PM
I appreciate your response. It looks like you are trying to say that G0447 may not be paid when billed with other codes but the representative kept telling me that UHC wants to see a modifier with G0447. In fact, she put the claim for reprocessing. I recieved a letter from UHC asking to give the visit notes and I send the visit note to UHC. UHC did reimburse G0447 later on but I still don't know what modifier they were looking for. Any help is appreciated.

 
kbarron
re: Modifier to use for G0447 when billing with E/M 99201-99215 to UHC
Posted:
Apr 25 2013, 12:07 PM
going by MLN Matters (MM7641 dated March 7, 2012)" Obesity counseling is NOT separately payable with another encounter/visit on the same day. This does not apply for IPPE claims, claims containing 59 and 77x claims containing Diabetes Self Management Training and Medical Nutrition Therapy Services.". UHC has their own guidelines of modifier usage. Good Luck

 
MedStudent2016
re: Modifier to use for G0447 when billing with E/M 99201-99215 to UHC
Posted:
Jul 11 2013, 1:33 PM
Hello:

I am a medical student looking for primary care practitioners conducting Intensive Behavioral Therapy (IBT) for Obesity as reimbursed by Medicare (G0447). My goal is to learn how different PCPs are conducting weight loss counseling. If you would be able to discuss this with me, please email me at Araba_Amonu@brown.edu. Thank you.

 

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