MedicaidDocumentationMedium impact
REVISED - BMI Assessment and Obesity-related Weight Management Follow-up among Children and Adolescents: Documentation and Claims Coding Instructions
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
Jan 24, 2014
We identified it
Jun 20, 2026
Summary
This Illinois Medicaid policy requires providers to document BMI percentile assessments for children ages 2-20 using specific ICD-9 codes and limits weight management visits to 3 per 6-month period for children with BMI >85th percentile. The policy clarifies coding requirements for obesity-related visits and mandates specific documentation in medical records.
Action Required
Immediately: Update billing workflows for pediatric BMI assessments to require ICD-9 codes V85.51-V85.54 on all claims where BMI is assessed. For children with BMI >85th percentile, limit weight management visits to maximum 3 per 6-month period using CPT codes 99204-99205 (new patients) or 99214-99215 (established patients) with obesity diagnosis codes 278.00-278.02. Providers must document BMI percentile, assessment date, and management plans in medical records. Cannot bill weight management visits same day as preventive medicine visits.