Billing for Exercise Is Medicine: An Analysis of Reimbursement Trends for Physical Activity-Related Billing Codes

BACKGROUND

Physical inactivity is a significant health risk factor linked to chronic diseases and premature death. To address this, initiatives like Exercise is Medicine® aim to promote physical activity in health care systems. However, integrating physical activity counseling into clinical practice faces barriers such as limited reimbursement. Understanding billing practices and reimbursement rates for physical activity counseling is crucial for its integration into health care.

METHODS

This study used 12 months of billing data from a large midwestern US hospital. Variables included charges, charge amounts, primary payors, reimbursement rates, and denial rates associated with International Classification of Diseases-10 diagnosis codes, and Evaluation and Management billing codes for physical activity counseling. Logistic regression analysis identified factors associated with denial rates.

RESULTS

Over 12 months, 19,366 lifestyle-related charges were submitted, totaling $7,842,845. Of these, 5.28% were denied, amounting to $414,446. The most common International Classification of Diseases-10 codes were "obesity" (38.8%) and "sedentary lifestyle" (32.6%), while the most common Evaluation and Management codes were for established outpatient office visits. Charges were mainly submitted to employer-paid insurance (43.5%), Medicaid (22.2%), and Medicare (21.9%). Higher odds of denial were associated with newer patients, shorter visit lengths, and the sedentary lifestyle code.

CONCLUSION

This study provides novel data on the use, reimbursement, and denial rates of physical activity counseling billing codes in a large health care system. Physical activity counseling-related charges are rarely denied by third-party payors. Further research is needed to determine if these findings are generalizable to other US health care systems.