Billing insurance companies for nutritional counseling can often feel more like an art than a financial act. Learning which codes each insurance payer will reimburse for, and for how many nutrition counseling sessions can be a tutorial all on its own. If you’ve just become in-network with CIGNA as a nutrition provider, we’re here to help you understand the basics of billing CIGNA.

In this article, we cover which diagnosis codes and CPT codes to use when billing CIGNA, when to obtain a referral, and how to submit insurance claims with CIGNA for nutrition professionals.

How many nutrition counseling sessions will CIGNA reimburse for?

CIGNA’s preventive care coverage complies with the Patient Protection and Affordable Care Act (PPACA) — which means that CIGNA will reimburse for up to 3 nutrition counseling sessions annually when billed as preventive services. As these are preventive services, they are typically covered at 100%, with no copay or deductible owed for clients. While additional coverage may be reimbursed, it may vary depending on your state, your client’s plan, and the billing codes used. Healthie’s new free Starter plan can handle all of your billing needs. Click here to learn more about our all-in-one practice management software today.

CIGNA, like other major insurance payers, should be billed according to units — which represent the total amount of time spent with your client in-session. For most billing codes with an individual client, 1 unit represents 15 minutes. For example, a 60 minute consultation will be billed as 4 units.

You can read more about CIGNA’s Preventive Health Coverage on their website.

Which CPT codes and diagnosis codes should I use when billing CIGNA?

When billing CIGNA for preventive nutrition services, the proper diagnosis code needs to be used in conjunction with your CPT code. Per CIGNA’s policy, if claims for preventive care services are submitted with diagnosis codes that represent treatment of illness or injury as the primary (first) diagnosis on the claim, the service will not be identified as preventive care and your patients’ claims will be paid using their normal medical benefits rather than preventive care coverage.

CPT codes and diagnosis codes for nutrition counseling preventive services are outlined below.

Nutrition/Physical Activity Counseling, Behavioral Interventions: adults who are overweight or obese and have risk factors for cardiovascular disease; obese adults and children age six years and older

Allowed with a diagnosis code of Z71.3

• 97802 – Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
• 97803 – Medical nutrition therapy; reassessment and intervention, individual, face-to-face with the patient, each 15 minutes
• 97804 – Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
• S9470 – Nutritional counseling, dietitian visit

Allowed with any diagnosis code

• G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15
  minutes
• G0447 – Face-to-face behavioral counseling for obesity, 15 minutes
• G0473 – Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes

For CIGNA providers, here is a copy of the 2019 Preventive Care Covered Service which further clarified how to combine CPT/modifiers and ICD10 code. Understanding CIGNA’s policies will save many phone calls and inaccurate information from representatives — and serves as a valuable document to refer to if an appeal is necessary.

Will CIGNA cover nutrition counseling after 3 sessions?

According to CIGNA’s policies, there are additional CPT codes “designated to report services provided to individuals at a face-to-face encounter, and are utilized for persons who have a behavior that is often considered an illness itself.” While this can relay to additionals like tobacco and substance abuse, CIGNA also includes obesity in this category. These additional “Behavior Change Intervention” services involve assessing readiness for change, advising a change in behavior, and motivational counseling, through the provision of follow-up nutritional care.

As much of nutrition counseling falls into CIGNA’s Behavior Change Intervention category, there is a logical need for ongoing nutrition support. After a client has exhausted their benefits coverage when billed for preventive services, CIGNA will generally reimburse for additional nutrition services by switching the billing code.

While CIGNA’s website indicates to use G0447, our community members have reported better success billing 99404 with the primary diagnosis code of Z71.3 and secondary diagnosis code indicating the client’s BMI.

• 99404 – Health promotion/prevention of injury/illness counseling

For nutrition counseling beyond obesity, CIGNA may cover for more sessions in your state. In this case, you can utilize a primary diagnosis code that identifies your client’s condition. Keep in mind, if you have a client with a behavioral or medical condition resulting in a diagnosis (such as an eating disorder) — you’ll need to obtain a chart note from your client’s doctor documenting the ICD-10 diagnosis code. Dietitians are unable to diagnose clients, so it’s best practice to obtain these diagnosis codes for a qualified wellness professional.

Can I bill CIGNA for telehealth services?

Telehealth reimbursement by insurance payers varies depending on your state, and the state where your client resides. Our community members report success in billing CIGNA using the modifier code GT to indicate a telehealth session.

The best way to know if your client will be covered for telehealth services is by calling CIGNA directly and verifying benefits with a representative. You’ll want to call for each client, as coverage can vary based on plan and state.

How much does CIGNA reimburse for dietitians?

While billing with CIGNA is rather straight-forward, obtaining the fee schedule is a frequently reported issue amongst dietitians. Typically, a fee schedule is included in your contract with the insurance payer and represents how much you’ll be paid per billing unit. Many insurance payers provide the fee schedule upon request, but CIGNA is notorious for making it near impossible to obtain one. One reason for this less-than-forthcoming policy may be that billing as an out-of-network provider may actually have higher reimbursement rates than for in-network providers!

No matter which insurance payer you’re contracting with, we highly recommend obtaining a fee-schedule prior to signing the contract. This may delay your time to become an in-network provider, but you’ll be confident knowing how much you can expect to be paid per session.

Where should I submit my CIGNA claims?

Most nutrition providers choose to use a clearinghouse to submit their insurance claims, which includes billing CIGNA. Availity and Office Ally are two clearinghouses commonly used by dietitians. Be sure to select the correct CIGNA plan when creating your CMS-1500 claim, the specific plan(s) you are in-network with will be identified in your provider contract.

The image above shows how to select the correct CIGNA plan and associated Payer ID number through Healthie, a practice management platform for nutrition professionals. To set up a free Starter account for your nutritionist practice, click here.

Leveraging Healthie for CIGNA Billing

Healthie is an all-in-one practice management and EHR platform for nutrition and wellness professionals. Have all of the tools you need to run your practice, with flexible billing tools for both insurance-based practice and self-pay services. Healthie’s HIPAA-compliant features allow you to:

• Create new client paperwork for clients to complete electronically
• Use and customize nutrition charting templates
• Create and submit CMS1500 claims
• Send and receive E-Fax documents
• Create invoices and process client payments for self-pay services
• Provide clients with login access so they can securely message you, complete E-paperwork, upload documents, and keep a photo-based food journal