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Coding Tips for Medicaid’s Childhood Nutrition and Weight Management Services

Did you know that Medicaid covers nutrition and weight management services for patients younger than 21? 

If you didn’t, you’re not alone. Though this coverage went into effect in 2007, it’s been underused, with Medicaid receiving bills for about 100 visits a month. 

Initial assessments and reassessments are covered, as well as individual, family, or group weight management and nutritional counseling.  

Here’s how to correctly perform and bill for these services. 

Assessments 

Initial assessments and reassessments can only be performed by a physician or certified registered nurse practitioner (CRNP). The initial assessment must be completed and billed prior to the initiation of counseling. They may be performed the same day as a physical exam, complete EPSDT screen, office or clinic visit, or counseling.

The initial assessment, which determines if further services are needed, must be at least 30 minutes. Three assessments may be performed in any 365 consecutive day period.  

The reassessment gauges how much progress the child has made and whether services are still needed or need to be adjusted. They also must be 30 minutes, and four reassessments may be performed in any 365-day period. 

Providers should bill for assessments using five-digit diagnosis codes 278.00 through 278.02 along with the following V-codes: 

• V 85.52 for children with a BMI between the 5^th and 85^th percentile
• V 85.53 for children with a BMI between the 85^th and 95^th percentile
• V 85.54 for children with a BMI at the 95^th percentile or above 

CPT code 96150 and modifiers U3 and TJ must accompany these diagnosis codes for initial assessments, and CPT code 96151 and modifier TJ must accompany these diagnosis codes for reassessments. 

Counseling 

Counseling will be covered if an initial assessment has already been provided. Nutritional counseling must be provided by a registered dietitian who is enrolled in Medicaid. 

Weight management counseling should focus on topics like caloric intake and physical activity, while nutritional counseling should focus on proper nutrition and eating behaviors. Weight management counseling is limited to 24 15-minute units of service or clinic visits in a 365-day period. 

For more information, read the Medicaid bulletin on childhood nutrition and weight management services and the bulletin clarifying the services.