Microlife's MedGem Weight Management Solution Practice Solutions provides a reimbursable model for healthcare providers.
Microlife Medical Home Solutions Inc. MedGem Weight Management Solution programs are cost-effective for physician practices. Standard CPT, E/M, & MNT codes are applicable with the MedGem® indirect calorimeter program.
Indirect Calorimeter (IC) Reimbursement
Many payers including Medicare, Medicaid, and private insurance companies reimburse IC evaluation for patients with pulmonary, cardiovascular, and metabolic disease. Medicare indicates "Service performed in connection with the treatment of obesity are covered by Medicare when such services are an integral and necessary part of a course of treatment for diseases such as: hypothyroidism, Cushing's disease, hypothalamic lesions, cardiovascular diseases, respiratory diseases, diabetes, and hypertension."
The amount reimbursed varies by region, payer, and policy. Currently, the allowable coverage by Medicare is between $50-$80. For the latest allowable rate by Medicare visit the CMS physician fee schedule website. The allowable rate by private insurance carriers is between $60-$100.
CPT Codes
94680 Oxygen uptake, expired gas analysis, rest and exercise, direct, simple.
94690 Oxygen uptake, expired gas analysis, rest, indirect (seperate proceedure).
ICD-9 Codes
Currently, only Medicare reimburses IC for patients with known pulmonary disease. The MedGem measurement may not be considered medically necessary for asymptomatic overweight patients. Private insurance carriers are likely to reimburse for IC evaluation in patients with co-morbid conditions secondary to excess body weight or obesity.
* Medicare indicates medical necessity for IC measurement
*323.2 | Sleep Apnea, Hypoventilation
| *416.0 | Chronic pulmonary heart disease |
250.1 | Diabetes Mellitus | *428.0 | Heart failure
|
272.1 | Hypercholesterolemia | *493.0 | Asthma
|
272.4 | Hyperlipidemia | *496.0 | Chronic airway obstruction
|
277.7 | Metabolic Syndrome | *517.8 | Lung involvement in other diseases classified elsewhere
|
278.0 | Obesity
| *780.5 | Sleep Disturbance |
401.1 | Hypertension
| 783.1 | Abnormal weight gain |
414.0 | Cardiovascular disease
| *786.0 | Dyspnea, shortness of breath |
MedGem Weight Management Solution Reimbursement Guide
For additional reimbursement information please contact Microlife Medical Home Solutions at info(at)mimhs.com
