Insurance Coverage for Dietary Counseling
Learn about the different nutritional and dietary counseling services that health insurance companies will cover.
Are you interested in taking health insurance at your private practice?
For dietitians, accepting insurance provides a way to drive new clients and build a successful practice. The good news is that most private and public insurance payers, now cover medical nutrition therapy services and dietary counseling provided by dietitians.
In this article, we’re covering the basics to insurance credentialing, including:
- What nutrition services are generally covered by insurance payers
- Which major insurance payers typically credential dietitians
- Important resources for beginning the insurance credentialing process
What nutrition services are covered by health insurance?
When the Affordable Care Act was enacted in 2010, obesity became a medically recognized disease. Since then, 33 states have begun to require full or partial coverage for bariatric surgery and/or nutritional counseling and this trend is only expected to further develop as nutritional therapy, weight loss counseling, and behavioral therapy prove to be an effective treatment.
However, coverage today still very much depends on an individual’s health insurance plan and what preexisting conditions may qualify him or her for coverage. Even clients with the same insurance beneficiary may see variances in their benefits, depending on their membership plan. Coverage is determined based on the diagnosis code for your client and the CPT (treatment) code used.
Diagnosis codes are based on the ICD-10 which lists all medical conditions and their corresponding code which insurance payers recognize. Typically diagnoses are provided by your client’s doctor (as dietitians are not able to diagnose clients) through a medical chart note or written referral.
The treatment codes approved for dietitians include:
- 97802: For an initial assessment, face-to-face, 15 minutes per unit
- 97803: For a follow up visit or reassessment, face-to-face, 15 minutes per unit
- 97804: For a group visit (2 or more individuals), 30 minutes per unit
- G0270: a 15-minute individual session for MNT reassessment and subsequent interventions following a second referral in the same year for a change in diagnosis, medical condition, or treatment regimen; and
- G0271: a 30-minute group session for MNT reassessment and subsequent interventions following a second referral in the same year for a change in diagnosis, medical condition, or treatment regimen.
While other codes exist, the above listed codes are most typically used in nutritional care.
Preventive Care Services
Many insurance payers will cover for a certain amount of nutrition counseling each year under preventive services. Typically, the diagnosis codes that indicate preventive services are Z codes, including Z71.3 for “dietary counseling and surveillance.” Other codes are listed to reflect body weight, with obesity being the diagnosis requiring nutrition counseling, such as E66.9 “obesity, unspecified.”
Beyond preventive services, and obesity, many insurance payers will reimburse for medical nutrition therapy services such as:
- Chronic kidney disease
- Crohn’s disease
- Celiac disease
- Hyperthyroid, Hashimoto’s
Nutrition Therapy Services
While insurance coverage can vary wildly, more insurance payers are beginning to reimburse for nutrition therapy services in the treatment of eating disorders. Anorexia, Bulimia, and Binge Eating are all recognized medical conditions under DSM10. If you work with clients that have eating disorders, then you may want to do some local research to determine which plans in your area may provide coverage. Start by seeing out eating disorder treatment facilities, outpatient ED treatment programs, and local therapists that specialize in ED — and assess which insurance plans they currently are accepting. While this may not reflect nutrition coverage, it can give you a place to start. From there, you can look into these insurance plans, and determine whether they 1) credential dietitians to be in-network 2) reimburse for any nutrition counseling services with ED diagnosis codes.
Insurance Coverage for Major Insurance Payers
Under Medicare, the federal health insurance program for people 65 years and older, nutrition services are reimbursed with generally good reimbursement rates. Medicare only provides reimbursement to dietitians directly at this time with a diagnosis of diabetes, chronic kidney disease, or with a kidney transplant within the past 36 month. Additional nutrition counseling services may be reimbursed when provided incident-to a physician.
Aetna limits individual and/or group counseling sessions to 26 over a 12-month period for the same qualifying individuals with a BMI of 30 or higher. With Aetna’s plan, there is also a list of services considered medically necessary for the evaluation of overweight and obese individuals. When criteria is met from these evaluations, counseling or even bariatric surgery are considered necessary.
Cigna covers nutritional counseling but to what extent and how many sessions that covers varies much by plan. Luckily, most Cigna plans do cover the full cost of counseling sessions.
When determining which insurance companies to become in-network with, it’s best to do some market research. Learn which insurance plans the major medical facilities, hospitals and nearby medical offices accept. Research which plans other dietitians in your area are in-network with. The larger insurance providers in your area will provide you with the most client referrals.
What are the benefits of accepting health insurance in nutrition practice?
For dietitians, accepting insurance in private practice can expand your client base and drive referrals. Many clients are seeking ways to access affordable nutritional care, and accepting insurance allows clients to save on their healthcare costs. Although there is a learning curve initially in understanding insurance billing and coding, many dietitians in private practice can confidently manage their own billing.
How to Get Started with Accepting Health Insurance
After you make your list of insurance companies that you’d like to credential with in your area, it’s best to reach out to each company and ask if they are accepting new providers for your locale. The network may currently be saturated, and no no applicants are permitted. Otherwise, you’ll be directed to fill out an application to become an in-network provider. Each insurance company will have their own unique application, but all providers will need access to review your CAQH profile. CAQH ProView is a credentialing database that allows insurance companies to view and verify your professional and practice information for claims administration, credentialing, directory services, and more.
The insurance credentialing process can take several months, from 3-9 months to become a credentialed in-network provider. In the meantime, you can still counsel clients at self-pay rates as well as put the proper systems in place to begin insurance billing. With insurance billing tools like Healthie, that integrate with your EHR — dietitians can seamlessly chart on clients and create CMS 1500 claims in minutes. This saves times and ensures more accurate claims, improving approval for submitting claims.
Ready to learn more about insurance credentialing?
Visit these Healthie resources to help you take the next steps:
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