MedicaidDocumentationMedium impact
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
Oct 3, 2013
We identified it
Jun 20, 2026
Summary
This policy establishes documentation and billing requirements for BMI assessment and weight management visits for pediatric patients ages 2-20. Providers must document BMI percentile annually and can bill up to 3 weight management visits over 6 months for children with BMI ≥85th percentile using specific ICD-9 codes.
Action Required
Immediately: Update billing workflows to require BMI percentile documentation for all pediatric patients ages 2-20. Add ICD-9 codes 278.00-278.02 and V85.51-V85.54 to billing system. Train staff on 3-visit maximum rule for weight management (BMI ≥85th percentile) over 6 months. Update encounter forms to prompt BMI documentation and ensure weight management visits are not billed same day as preventive medicine visits.