Practitioners can receive reimbursement for lung health education for patients with Blue Cross Complete

Despite a strong correlation between asthma education and improved patient outcomes, fewer than 10% of Michigan asthma patients receive regular self-management education during health care visits, according to medical billing records. Additionally, research has shown that children with asthma who receive regular education have improved lung function, reduced school absenteeism and fewer visits to emergency departments.

Increasing patient education is a core mission of Inspiring Health Advances in Lung Care, or INHALE, a recently launched collaborative quality initiative that is supported by Blue Cross Blue Shield of Michigan. INHALE leadership identified the low education rate as an early priority for the CQI and worked collaboratively with the Asthma Initiative of Michigan to advocate for the Michigan Department of Health and Human Services to accept asthma education as a Medicaid-covered service for Michigan providers.

As a result of these efforts, demonstrating and evaluating patient use of respiratory medications and devices became a covered service for Michigan physicians, practitioners, medical clinics, health departments and child and adolescent health centers providing services to patients with Blue Cross Complete, Blue Cross’ Medicaid plan, in January 2022. The anticipated reimbursement rate is $9.91 per visit through CPT code *94664.

“Drug delivery to the lungs is exceptionally difficult, and teaching patients how to use their medications reduces side effects and improves asthma control and quality of life,” said Njira Lugogo, M.D., INHALE’s program director and Michigan Medicine’s asthma program director. “This change in billing coverage enables providers to receive reimbursement for patient education, which is a critical component of asthma care. Ultimately, the goal is for patients with asthma to live full and productive lives unaffected by asthma.”

For more information

• To learn more about INHALE, see the article in the May-June issue of Hospital and Physician Update.
• Providers who have questions about INHALE are encouraged to email contact@inhalecqi.org.