Insurance Coverage for Nutrition Counseling

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Medical nutrition therapy (MNT) is an example of specific health care service that may be included as a benefit through your health insurance policy.

ICYDK…Medical Nutrition Therapy Can Help You Improve Your Health! 

Medical Nutrition Therapy (MNT)  includes diagnostic, therapy, and counseling services for the purpose of disease management. Essentially it is a therapeutic approach which helps to prevent or treat certain chronic conditions and health issues through an individually-tailored nutrition plan. ​​

Your MNT nutrition plan is developed by our Registered Dietitians and is based on your medical history, health condition, lifestyle and wellness goals. It includes:

Nutrition Counseling: A supportive process to set priorities, establish goals, and create individualized action plans which acknowledge and foster responsibility for self-care.

Nutrition Education – Reinforcement of basic or essential nutrition-related knowledge.

Some individuals may have benefits limited to certain diagnoses/conditions whereas other individuals may have benefit coverage for any condition, or for any condition if the criteria stated in the coverage details are met.

We highly encourage new clients to call their insurance company PRIOR to their visit to confirm coverage. 

We just don’t want our patients to have ANY surprise bills. 

Do I have nutritional counseling coverage on my insurance plan?

• Locate the 800 member services number on the back of your insurance card.
• If the insurance company asks for a CPT code please provide them with the following codes 97802 & 97803. If they say you do not have coverage using those codes NEXT ask them to check your coverage for the following CPT codes: 99401, 99402, 99403 and 99404. 

Will my diagnosis be covered?

• If the representative asks for a diagnosis code (aka ICD 10 code) – please tell them the visit is coded the ICD 10 code: Z71.3
• If they don’t accept Z71.3 then provide them with Z72.4 and see if they will cover that diagnosis instead of your plan. 
• If you are overweight, obese, have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well. 
• We always code your visit using preventative coding (if applicable) to maximize the number of visits you receive from your insurance carrier. However, if you ONLY have a medical diagnosis (for example: IBS, and you are not overweight or have CVD risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance. 

How many visits do I have per calendar year?

• Your carrier will let you know how many visits they are willing to cover. Depending on the carrier the number of visits vary from 0 to unlimited depending on medical need.

Do I have a cost-share for my nutrition visit?

• A cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay or co-insurance. 
• We will attempt to bill under your insurance policy’s plan under your preventative benefits if your plan allows. With that being said, if you have preventative benefits there are often NO cost share for you associated with the visit. Once again, this is something you do want to ask prior to your visit. 
• In the event you have a  cost-share we will initially bill your insurance company directly. Once we receive the EOB describing your responsibility as the patient, we will receive a patient statement in order to pay your cost-share. 
• For most insurance companies, dietitians are considered a specialist. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card. However, often because we bill your insurance with preventative counseling the co-pay is often not applicable.
• We generally wait for the claim to be processed to determine whether or not you have a copay and then charge the credit card you have on file with us the co-pay amount. 

Why does my deductible need to be met before sessions are paid by insurance?

• A deductible is a part of cost sharing. Some insurance plans require that you satisfy your deductible before medical services are covered. If this is a requirement,  you’ll pay 100% of covered medical expenses until your deductible is met. Once a policyholder meets their plan’s deductible, most plan holders typically pay only a copayment or coinsurance for additional covered services up to an out-of-pocket maximum.

Summary of questions to ask to verify your nutrition benefits:

• Do I have coverage for nutrition counseling?
• Do I need a referral to see a Registered Dietitian?
• Are my diagnoses covered on my particular plan?
• How many visits per calendar year do I receive?
• Do I have a cost-share for these services?
• Is there an associated cost for me if I choose to have the appointment as a telehealth visit versus in person visit?

Meal plans or shopping lists

Personal training or recommendations for daily/weekly physical activity

Stress management or sleep recommendations

Specialized testing

Prior to your session you must complete/sign all intake documentation including:

• Intake Form
• Acknowledgement of Notice of Privacy Policy and Telehealth Consent
• Acknowledgement of Financial Responsibility 

Your session will run for at least 60 minutes. During your session, we will:

• Identify current lifestyle behaviors to improve upon
• Determine SMART goals
• Provide nutrition education and counseling

Follow-up sessions run between 30 and 60 minutes. Your session includes:

• Monitoring/evaluation of progress toward SMART goal and interventions set forth during initial session
• Addressing barriers to change
• RD to provide accountability/support and ongoing education

In both the initial session and follow up session, clients will be provided with educational tools to help provide support in meeting SMART goals. Tools include educational handouts and exercises/homework.

We will process the session claim after your visit. Submission to your insurance provider does not guarantee payment by them and your total out-of-pocket cost will depend on your exact insurance plan. As the policyholder, you are responsible for claims denied by insurance.

If you are responsible for a copay, co-insurance, or deductible, you can expect to receive a bill from Carter Hall Lifestyle via either email, text, or a note in the mail. If you have questions around copayment, deductibles, and out-of-pocket charges, please confirm with your insurance plan directly.