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.
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Call the member services number on the back of your card or call your HR rep/benefits coordinator at work.
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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).
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Ask if there are any diagnosis code exclusions.
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Ask if there is a visit limit maximum.
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Ask if nutrition counseling is eligible for telehealth (virtual sessions) with your plan.
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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".
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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)