Posted in BCBS (Various States), Training, Updates

BCBS Michigan: Genetic Counselors to receive direct payment 01/01/2022

What genetic counselors do?
Genetic counselors obtain and evaluate individual, family and medical histories to determine the risk for genetic or medical conditions or diseases in a member, the member’s descendants or other family members.
Genetic counselors explain to the member the clinical implications of genetic laboratory tests and other diagnostic studies and their results.

According to BCBS of Michigan genetic counselors have an opportunity to participate in BCBS of Michigan’s Traditional and TRUST PPO networks, and BCN commercial, effective Jan. 1, 2022.

This change, effective for outpatient services provided on or after Jan. 1, applies to Blue Cross and BCN benefit plans that cover services that these providers are licensed to provide.


How to Enroll?

Genetic counselors can find enrollment forms and practitioner agreements on bcbsm.com/providers. To find enrollment information, click on Enroll to become a provider. Specific qualification requirements are identified within each agreement. All applicants must pass a credentialing review before participation. BCBS of Michigan will notify applicants in writing of their approval status.


Checking Member Benefits:

To find out if a member has coverage, check web-DENIS for member benefits and eligibility or call Provider Inquiry at 1-800-344-8525

Medical Billing:

Participating Genetic Counselors are allowed to directly bill codes to BCBS of Michigan:

*96040 and S0265, under professional services.

Reimbursement Rate:

Directly billed codes will be reimbursed at 85% of the applicable fee schedule, minus any member deductibles and copayments.

Prior Authorization Requirements:

Genetic Counseling does not require an authorization. For BCN commercial members who have a primary care physician that is part of a medical care group based in the East or Southeast region, their primary care provider must submit a referral for a specialist office visit. Referrals are not required for other members.

To learn more about BCBS of Michigan Genetic Testing and Counseling, please click here to read the full policy.


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Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)

HEDIS is always a hot topic of discussion. In this blog post we will discuss the HEDIS measure WCC or Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents.

Background/Research Data:

The research analyzed doctor visits pre-pandemic then during the pandemic period and the increases were dramatic. Overall obesity increased from 13.7% to 15.4%. Increases observed ranged from 1% in children aged 13 to 17 years to 2.6% for those aged 5 to 9 years.


The purpose of this HEDIS Measure:

This HEDIS measure looks at the percentage of patients between the 3-17 years of age, who had an outpatient visit with a PCP or OB/GYN and have documented evidence for all the following during the measurement year:

  • Body mass index (BMI) percentile (percentage, not value)
  • Counseling for nutrition
  • Counseling for physical activity

This HEDIS Measure (WCC) requires the following documentation:

  • When counseling for nutrition, document current nutritional behavior, such as meal patterns, eating and diet habits, and weight counseling.
  • When counseling for physical activity, document current physical activity behavior, such as exercise routine, participation in sports activities, bike riding and play groups.
  • Handouts about nutrition and physical activity also count toward meeting this HEDIS measure when documented in the member’s health record.

Telehealth, virtual check-in, and telephone visits all meet the criteria for nutrition and physical activity counseling. Counseling does not need to take place only during a well-visit, WCC can also be completed during sick visits. Documenting guidance in your patient’s records is key.



Proper Coding and Billing:

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