USING INSURANCE

Ask your insurance provider:

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“Do I have coverage for nutrition counseling?”

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If they request CPT (billing) codes, provide the following:

• 97802 (Initial nutrition assessment)

• 97803 (Follow-up nutrition counseling)​

 

If coverage is denied under those codes, ask them to check the following preventive counseling CPT codes:

• 99401, 99402, 99403, 99404

 

In some cases, we may also bill S9470 if it is a covered benefit under your plan.
 

Diagnosis Coverage

 

If the insurance representative asks for a diagnosis (ICD-10) code, you can state that the visit is billed under:

• Z71.3 (Dietary counseling and surveillance)

If your plan does not accept Z71.3, ask whether Z72.4 is covered instead.

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Additionally, if you have any of the following conditions, you may want to ask about coverage related to those diagnoses:

• Overweight or obesity

• Prediabetes or diabetes

• Hypertension

• High cholesterol​

 

When appropriate, visits are billed using preventive coding to help maximize covered benefits. However, if your visit is based solely on a medical diagnosis (for example, IBS without cardiometabolic risk factors), your plan may apply a deductible, copay, or coinsurance.

Number of Covered Visits

 

Coverage varies widely by insurance carrier and plan and may range from 0 visits to unlimited visits based on medical necessity. Ask how many visits are covered under preventative care specifically, as these do not typically impose a cost-share in the form of a deductible, co-pay or co-insurance.

Cost-Share Information

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A cost-share is the portion you may be responsible for paying, such as:

• Deductible

• Copay

• Coinsurance​

If your plan includes preventive nutrition benefits, there is often no cost-share, but this must be confirmed directly with your insurance provider.

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If a cost-share applies:

• We will submit the claim to your insurance first.

• Once we receive the Explanation of Benefits (EOB), the card on file will be charged for the amount listed as patient responsibility.

 

Many insurance plans classify Registered Dietitians as specialists, meaning a specialist copay may apply. However, when preventive counseling benefits are used, the copay is often waived. We typically wait for the claim to process before determining whether a copay is due.

Questions to Ask Your Insurance Providers

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• Do I have coverage for nutrition counseling?

• Do I need a referral to see a Registered Dietitian?

• Are my diagnoses covered under my plan?

• How many visits are covered per calendar year?

• Will I have a deductible, copay, or coinsurance?

• Does this cover telehealth visits?

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Still have questions?

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No problem. Reach out to Brittani directly at brittanidasilvard@gmail.com