Checking your benefits
New clients: We are happy to run a preliminary benefits check before your initial session. You can also check on your own following the steps below.
Existing clients: It is highly recommended that you reconfirm your coverage when your policy renews annually. Confirming your benefits is easy!
Commercial Insurance Plans
We are in-network with Blue Cross Blue Shield PPO and Blue Choice plans, UnitedHealthcare* and Cigna.
Call the member services number on the back of your card or call your HR rep/benefits coordinator at work.
Ask them if your plan covers nutrition counseling: CPT Codes 97802 and 97803. If they ask for a provider NPI use 1881159309 (for Blue Cross plans) or 1457842395 (for UHC and Cigna Plans).
Ask if there are any diagnosis code exclusions.
Ask if there is a visit limit maximum.
Ask if nutrition counseling is eligible for telehealth (virtual sessions) with your plan.
If they say you don't have coverage, ask if you have coverage for nutrition counseling or Medical Nutrition Therapy under preventative care or the "Healthcare Reform Act".
At the end of the call get a reference number and keep it for your records.
*Unitedhealthcare provides narrow coverage for nutrition counseling. Generally it will be covered with a BMI > 30 and a cardiovascular risk factor (hypertension, high cholesterol, diabetes). They will also require a doctor's referral that should include covered diagnosis codes. See pages 20, 22 and 23 of UHC's preventative care services list - Link
Medicare Part B
Currently Medicare B covers nutrition counseling for patients with Diabetes or Chronic Kidney Disease (see restrictions below). A benefits check is NOT necessary, but you must meet the criteria below.
They cover 3 hours of nutrition counseling in the first year of service (and possibly some bonus time). You need to obtain a doctor's referral with your doctor's name, signature, date, NPI number; and the corresponding diagnosis codes for diabetes or chronic kidney disease.
You will need documentation/lab results showing one of the following:
• Fasting glucose > 126 mg/dl on two different occasions
• 2-hour post glucose challenge > 200 mg/dl on two different occasions
• Random glucose test > 200 mg/dl for a person with symptoms of uncontrolled diabetes
Medicare will reimburse MNT services for patients with non-dialysis kidney disease who meet these criteria:
• The patient has chronic renal insufficiency (i.e., reduction in kidney function that is not severe enough to require dialysis or transplantation; Glomerular Filtration Rate (GFR) 13– 50 ml/min/1.73m2 )
• The patient has end stage kidney disease, but is not on dialysis (i.e., non-dialysis kidney disease)
• The patient has had a kidney transplant (and is eligible for MNT up to 6 months after the transplant)