Nutrition Counseling for Obese Adults with Medicaid

Obesity affects more than 31.6 percent of South Carolinians. The cost of obesity related to medical treatment is $147-$210 billion dollars. As part of the South Carolina Obesity Action Plan (PDF), our state has outlined targeted objectives in key settings for obesity prevention and promotes statewide changes at the environmental, policy, and systems level. The objectives of the action plan are addressed through the work of the Scale Down Initiative.

Program Overview

The initiative’s goals are to enable health care providers to treat obesity as a disease and bill accordingly. Ultimately, this will help reduce obesity rates in South Carolina and improve health outcomes.

To meet this need, SC Department of Health and Human Services Healthy Connections Medicaid developed a policy that allows registered, licensed dietitians with the RDN, LD credential to be reimbursed for up to six nutrition counseling sessions with patients who carry Medicaid Insurance.

Patient Requirements

• Medicaid insurance (four of the six HMOs are accepted. Note: At MUSC Health, Wellcare of SC and Blue Choice Healthplan Medicaid SC are not accepted.) 
• Adults with a body mass index (BMI) of 30 kg/m2 or greater who are committed to losing weight through diet and exercise.
• Children with a BMI at the 95th percentile or greater will continue to be covered through the Medicaid Early Periodic Screening Diagnosis and Testing Program.

Excludes the Following

• Beneficiaries authorized for bariatric surgery/gastric banding
• Dual eligible (enrolled in both Medicare and Medicaid)
• Pregnant women
• Beneficiaries whose medication may cause weight gain. Example medications include:
  • Atypical antipsychotics
  • Long-term use of oral corticosteroids
  • Certain anticonvulsant medications
  • Tricyclic antidepressants

Services Provided

• Six (6) visits with a physician, physician assistant, and/or nurse practitioner, and
• Six (6) visits with a licensed dietitian

Referral Process

Adult Patients need to be referred to a dietitian from their primary care provider who has ‘enrolled’ them in the policy by seeing them the first time, billing for the ‘Physician code’ (G0447, SC modifier) and Z-code for BMI (BMI>30 kg/m2).

Referring patients (PDF) to the MUSC Health Ambulatory Dietitian for nutrition counseling is a simple process for MUSC providers and outside providers.

MUSC Health providers can place an Ambulatory Referral to Nutrition Services in EPIC with the appropriate diagnosis code.

Providers outside of MUSC Health should fax the completed Adult Obesity Nutrition Counseling for Medicaid referral form (PDF) to 843-792-2995.

All Medicaid HMOs are eligible for the program – but MUSC Health does NOT accept the following Medicaid HMOs:

• WellCare of SC
• Blue Choice Health Plan Medicaid SC

Scheduling Process

Both internal and external patients are scheduled through the University Internal Medicine Scheduling Department at 843-876-0888.

Billing Process

The physician and dietitian billing codes and reimbursement rates are clearly outlined in the Billing Health care Common Procedure Coding System (HCPCS) Service Codes (PDF).