All PlansCoverageMedium impact
Combatting Childhood Obesity: How Highmark is Helping Parents and Providers
Highmark·DE, NJ, NY, PA, WV · Pediatrics, Family Medicine, General Practice·Provider Bulletin
We identified it
Jul 28, 2026
Summary
Highmark has expanded preventive health benefits for children ages 2-18 with BMI in the 85th percentile or greater, now covering three annual obesity-specific follow-up visits, unlimited annual nutritional counseling, and one set of recommended annual lab work (cholesterol, A1c or fasting glucose, and AST). Billing teams must ensure proper documentation of Weight Assessment and Counseling (WCC) HEDIS measure components and use appropriate codes for these newly covered services.
Action Required
Immediately: Providers and billing staff must ensure documentation in the medical record captures all three WCC HEDIS measure components (BMI Percentile, Nutrition Counseling, Physical Activity Counseling) for children ages 2-18 with BMI ≥85th percentile. Billing team must: (1) Review Highmark's coding guidance document for appropriate CPT codes for obesity-specific preventive visits, nutritional counseling, and lab work; (2) Update encounter forms and EMR templates to prompt providers to document each WCC component separately; (3) Configure billing system to recognize these services as covered benefits under the expanded preventive benefit; (4) Train front-desk and clinical staff on eligibility criteria (age 2-18, BMI ≥85th percentile) to ensure proper routing and claim submission. Contact Highmark Provider Resource Center via Availity Essentials for the complete CPT coding reference. Claims lacking documentation of all three WCC components may be denied or rejected for HEDIS measure non-compliance.