Checking your benefits

New clients: Check your insurance benefits to ensure your insurance covers nutrition counseling  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*, Aetna** and Cigna. 

Call the member services number on the back of your card or call your HR rep/benefits coordinator and ask the following:

  1. Does my plan cover nutrition counseling: CPT Codes 97802, 97803, 97804, S9470 or 99404 ?

  2. Are any diagnosis code exclusions?

  3. Is there a visit limit maximum?

  4.  Is telehealth (virtual sessions) covered?

  5. If they say you don't have coverage, ask if you have coverage for nutrition counseling or Medical Nutrition Therapy under preventative care under the "Healthcare Reform Act" OR ask if they will partially reimburse you if Nutriquity provides you a superbill for any session you pay for out-of-pocket.

  6. At the end of the call get a reference number and keep it for your records.

*Unitedhealthcare patients please check your benefits as coverage varies by plan. Generally it will be covered with a BMI > 30 - diagnosis code E66.9 or with diagnosis code e66.3 + a cardiovascular risk factor.    See pages 20-23 of UHC's preventative care services list.

** Aetna members will need a doctors referral with one or more of the ICD-10 codes listed HERE.

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)