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The Status of Billing and Reimbursement in Pediatric Obesity Treatment Programs

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Abstract

Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service.

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Acknowledgments

The authors wish to acknowledge the important contributions of the colleagues who responded to our request for feedback about billing and reimbursement, and our funding from the Michael & Susan Dell Foundation (to first author), the National Institutes of Health (DK 068221 to fifth author) and the Health Care Foundation of Greater Kansas City (to fifth author).

Conflicts of interest statement

The authors have no conflicts of interest to report.

Author information

Authors and Affiliations

  1. Texas Center for the Prevention and Treatment of Childhood Obesity, Texas Child Study Center, Dell Children’s MedicalCenter, 4900 Mueller Blvd, Austin, TX, 78723, USA

    Jane Simpson Gray PhD

  2. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave MLC 3015, Cincinnati, OH, 45229, USA

    Stephanie Spear Filigno PhD

  3. Connecticut Children’s Medical Center, Hartford Hospital/The Institute of Living, Hartford, CT, USA

    Melissa Santos PhD

  4. Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children’s Hospital, 1 Children’s Way, Slot 512-21, Little Rock, AR, 72202-3591, USA

    Wendy L. Ward PhD

  5. Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, Kansas, 66160, USA

    Ann M. Davis PhD, MPH, ABPP

Authors
  1. Jane Simpson Gray PhD
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  2. Stephanie Spear Filigno PhD
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  3. Melissa Santos PhD
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  4. Wendy L. Ward PhD
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  5. Ann M. Davis PhD, MPH, ABPP
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Corresponding author

Correspondence to Jane Simpson Gray PhD.

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Gray, J.S., Spear Filigno, S., Santos, M. et al. The Status of Billing and Reimbursement in Pediatric Obesity Treatment Programs. J Behav Health Serv Res 40, 378–385 (2013). https://doi.org/10.1007/s11414-012-9308-9

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  • DOI: https://doi.org/10.1007/s11414-012-9308-9

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