Healthier Generation Benefit

Healthier Generation Benefit

A benefit to children and families for the prevention, assessment and treatment of childhood obesity.

Introduction to the Healthier Generation Benefit

In August 2013, Blue Cross and Blue Shield of Kansas City (Blue KC) joined the American Academy of Pediatrics and the American Academy of Dietetics to collaborate with the Alliance for a Healthier Generation, to offer a benefit to children and families for the prevention, assessment and treatment of childhood obesity. The information below explains the benefit, eligible employer groups and reimbursement. Should you have any questions about the benefit or are interested in getting more information, please contact your Provider Relations Representative.

What is the Healthier Generation Benefit?

The Healthier Generation Benefit (HGB) is a three-year pilot program and promises to yield critical findings regarding what clinical steps are effective in preventing and treating childhood obesity.

Eligibility & Coverage

Please refer to the eligibility and coverage link below for details on eligible employer groups. We are offering insurance coverage to eligible children for four (4) visits with their primary care provider and four (4) visits with a Registered Dietitian (RD) per year. A list of recommended RDs is below. The benefit will process with no copayments for these members through an in-network provider.

Expanded CPT Codes:

The HGB has expanded the range of codes used. Beginning October 1, 2015, program visits should be coded with ICD-10 code range E6601-E669 in the primary position and CPT code range 99205 – 99215. Use V85.53 to record BMI of 85% to <95% or V85.54 to record BMI > 95% in the secondary diagnosis field.

Helpful Links

Who is Eligible?

To be eligible for the pilot program children must be covered by Blue KC and meet the following criteria:

  • Between the ages of 3 and 18
  • At or above the 85% BMI for age
  • No co-morbidity condition required
  • In one of the employer groups listed below

Eligible Employer Groups

Group Name Group Number Pilot Start Pilot Expected End
BCBSKC 10025000 August 1, 2013 December 31, 2016
Blue Valley SD 14274000 January 1, 2014 December 31, 2016
Clay County 31517000 January 1, 2014 December 31, 2016
Garmin International 11406000 January 1, 2014 December 31, 2016
Jackson County 31618000 January 1, 2014 December 31, 2016
KCK School District 32076000 January 1, 2014 December 31, 2016
KCMO Public Schools 11828000 January 1, 2013 December 31, 2016
KU Hospital 16379000 January 1, 2014 December 31, 2016
Lee's Summit SD 23671000 January 1, 2014 December 31, 2016
Metropolitan Community College 32129000 January 1, 2014 December 31, 2016
Olathe Health Systems Inc. 31596000 January 1, 2014 December 31, 2016
Olathe SD 11640000 January 1, 2014 December 31, 2016
Shawnee Mission SD 11455000 January 1, 2014 December 31, 2016
Board of Police Comm. 10825000 August 1, 2013 April 30, 2017
City of KCMO 24166000 May 1, 2014 April 30, 2017
JCCC 14092000 August 1, 2013 May 31, 2017

Reimbursement

The HGB has expanded the range of codes used. Beginning October 1, 2015, program visits should be coded with ICD-10 code range E6601 - E669 in the primary position and CPT code range 99205 – 99215. Use V85.53 to record BMI of 85% to <95% or V85.54 to record BMI > 95% in the secondary diagnosis field.

Claims for Registered Dietitians will be coded with ICD-10 code range E6601 - E669 in the primary position and CPT code range 97802 – 97804. Use V85.53 to record BMI 85% to < 95% or V85.54 to record BMI > 95% in the secondary diagnosis field.