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Date: July 11, 2019
To: All Health Plan of San Joaquin (HPSJ) Contracted Providers, Facilities, and Ancillary Services
From: HPSJ Quality Management Department
Subject: Important Information: HEDIS Tip Sheet, G0447
Business: Medi-Cal

The annual HEDIS Provider Tip Sheet is a tool used to inform providers of the value set codes published at the national level by the measure steward (the National Committee for Quality Assurance). The most recent version of the Provider Tip Sheet is posted on DRE.

In the new HEDIS tip sheet we now include only those codes payable by the Department of Health Care Services (DHCS) and medications found on the HPSJ preferred drug list. Due to changes in reimbursement, G0447 may not be used for children.

Effectively immediately, providers may continue to use G0477 for adult members ONLY with the corresponding DX code as listed below (to avoid obtaining prior authorization) during a PCP visit.

For children, refer to the preventive codes listed below and corresponding DX code. G0447 is recognized for HEDIS incentive payments, but denied through the claims process. More information can be found in the Preventative Services section of the Medi-Cal Provider Manual on the Medi-Cal website.

USPSTF Recommendation Topic CPT/HCPCS Codes ICD-10-CM Diagnosis Codes
Obesity screening and counseling: adults 97802 – 97804 G0447 G0473 Z00.00 Z00.01 Z68.30 – Z68.39 Z68.41 – Z68.45
Obesity screening: children and adolescents 99381 – 99384 99391 – 99394 Z00.121 – Z00.3

Considering DHCS will no longer reimburse for G0447 when applied to children, please expect HPSJ to recover claims payments made after January 1, 2019 for G0447 when applied in the context of children. HEDIS compliance will not be affected by claims recovery.

Thank you very much for being our partner in our commitment to provide quality care to our members. If you have any questions, please contact our Provider Relations Department at 209.942.6340; Monday – Friday, 8:00AM to 5:00PM.