Getting paid for evaluation and management (E/M) services provided to children who are overweight or obese is difficult for many reasons. One is that most state Medicaid programs and commercial payers do not pay for any services performed when related to the treatment or prevention of obesity. A second is the confusion over which Current Procedural Terminology (CPT®) codes are the most appropriate to report. The following may help practices understand coding for obesity-related services.

CPT E/M codes most often reported by the physician include

Codes 99401–99404 are used to report physician counseling services for the purpose of promoting health and preventing injury or illness. They are reported when a patient does not have an established illness or symptoms (ie, patient is not obese). Because these are time-based codes, the amount of time spent in counseling must be documented in the medical record. When counseling is provided to...

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