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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

 

Georgia Cancer Specialists
Atlanta, GAClick Here
 
Lake Cardiology
Mount Dora, FLClick Here
 
Miramont Family Medicine
Fort Collins, COClick Here
 
Southeast Endocrine & Diabetes
Roswell, GAClick Here
 
Westminster Medical Clinic
Westminster, COClick Here

MedGem Weight Management Solution Reimbursement Guide

 

For additional reimbursement information please contact Microlife Medical Home Solutions at info(at)mimhs.com