Metabolic Syndrome Management

Metabolic Syndrome is a set of 2-3 of the following risk factors that include: abdominal obesity, a decreased ability to process glucose (insulin resistance, dyslipidemia (unhealthy lipid levels), and hypertension. Members who have this syndrome have been shown to be at an increased risk of developing cardiovascular diseases and/or type 2 diabetes. The goal of the Metabolic Syndrome Health and Lifestyle Management Program is to help you track your individual health issues, assist you in addressing your health concerns and medical care, provide telephonic counseling as needed, educational materials, and other support to help improve your overall health. Member Benefits:     To begin utilizing the following benefits, you must enroll. Up to 3 office visits per plan year (height, weight, and blood pressure required) - Visit will be paid at 100% when provided by an in-network provider. CPT Codes: 99201-99215, 99241-99245, 99381-99404 Up to 3 HbA1c (glucose 3 month average) - paid at 100% when provided by an in-network provider. CPT Code: 83036 Up to 3 Fasting blood sugar (fasting glucose) - paid at 100% when provided by an in-network provider. CPT Code: 82947 Up to 3 Lipid profile (cholesterol, HDL, LDL, and triglycerides) - paid at 100% when provided by an in-network provider. CPT Codes: 80061 and/or 82465 1 Microalbuminuria - paid at 100% when provided by an in-network provider. CPT Code: 82043 1 Serum creatinine - paid at 100% when provided by an in-network provider. CPT Code: 82565 Up to 3 Visits to a Registered Dietician - paid at 100% when provided by an in-network provider. Annual foot exam by medical doctor Annual retinal exam (by Physician/Optometrist) CPT Codes: 92004, 92014, 92012, 99211 Free blood glucose monitor 1 visit to your local health screening per plan year. For additional information regarding health screening events, South Dakota Employee Health Plan members go to www.bopweb.com, Associated School Board member contact your business manager. Additional Benefits: Comprehensive educational material. One-on-one member counseling with a health coach to promote informed decision making and goal setting. You will be responsible for additional cost related to routine tests or lab work and any charges over "Usual and Customary and Reasonable" (UCR). Note: At your office visit, please inform the nurse to code the visit as cardiac, diabetes, weight or metabolic syndrome related (250.XX, 790.2, 790.21, 790.22, 790.29, 277.7, V70.9, V77, V77.1, V77.9, V77.91, V77.99, V82.9, 272.0, 272.4, 401.XX-414.9, 796.2, 277.7, V70.9, V71.7, V77, V77.91, V82.9, V81, V81.0, V81.1, V81.2) in order for the claim to be paid accordingly. You are encouraged to visit the Metabolic Syndrome Management website at www.hcmti.com/metabolicsyndrome for more information and to enroll. Members may utilize this site to access online resources that may be useful in managing your health issues. For questions, contact us @ 877-977-0159, or email: metabolic@hcmti.com. All information that is provided is strictly confidential.