Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 16, 2023

Change to Nutritional Counseling for Individuals with Obesity or Chronic Disease Benefit Limits

Please note, this communication applies to Anthem HealthKeepers Plus Medicaid products offered by HealthKeepers, Inc.

Effective August 1, 2023, HealthKeepers, Inc. will align the benefit limits for Nutritional Counseling for Individuals with Obesity or Chronic Disease with Virginia Department of Medical Assistance Services (DMAS) benefit limits. The list of impacted codes is noted below. This change will affect the current reimbursement policy and related claims processing rules associated with nutritional counseling services.

HealthKeepers, Inc. will no longer reimburse for any limit that exceeds the DMAS benefit limits for Anthem HealthKeepers Plus members.

HealthKeepers, Inc. will only reimburse providers for quantities exceeding DMAS limits when prescribed by a physician, documented on a Certificate of Medical Necessity, and authorized by HealthKeepers, Inc. HealthKeepers, Inc. follows the same criteria as DMAS in determining all medical necessity approval.

We recommend that providers visit the online provider manual to review all authorization, appeals, and reconsideration processes here: https://bit.ly/42V0QSC.

Code

Description

DMAS limit

97802

Medical nutrition therapy; initial assessment and intervention, face-to-face with the patient, each 15 minutes.

12 units per calendar year

97803

Medical nutrition therapy; reassessment and intervention, face-to-face with the patient, each 15 minutes.

12 units per calendar year

97804

Medical nutrition therapy, group two or more individual(s), each 30 minutes

Four units per calendar year

G0270

Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes

Eight units per calendar year

G0271

Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group two or more individuals, each 30 minutes

Four units per calendar year

S9470

Nutritional counseling, dietician visit

Eight units per calendar year

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800-901-0020.

VABCBS-CD-025555-23

PUBLICATIONS: July 2023 Provider Newsletter