Verifying Insurance Benefits

Do I have coverage for nutrition counseling or medical nutrition therapy?

• If the insurance company asks for a CPT code, please give them 97802 (medical nutrition therapy - initial assessment) and 97803 (medical nutrition therapy - follow up).

Is nutrition counseling covered as a preventative visit?

• Are there certain criteria that must be met to qualify. (e.g. “obesity” or cardiovascular risk factors?)

• If they ask for a diagnosis code (aka ICD 10 code) - give them ICD 10 code: Z71.3

• If they don’t accept Z71.3, provide them with Z72.4

Is nutrition counseling covered as a medical benefit?

• If so, are there any excluded diagnoses?

• If you are overweight, obese, have pre-diabetes, diabetes, hypertension, or high cholesterol you may also want to see what your coverage is for those diagnoses as well

Do I have coverage for services provided via telehealth?

• If you are located outside Washington State: Does my plan cover telehealth for providers located out of state?

Do I need a referral or prior-authorization to see a Registered Dietitian?

• If yes, please request a referral from your doctor at least one week prior to your appointment. You may provide them the fax number below

How many visits or hours per calendar year do I receive?

Do I have a cost-share for these services?

• This may be a deductible, co-pay, or co-insurance. 

• Often there is no cost share for preventative benefits.

• If you have a deductible, you may want to ask how much it is and how much you have remaining for this year.

• If you do have a cost-share, I will initially bill your insurance company directly. Once I receive the EOB describing your responsibility as the patient, I will bill the credit card on file for the amount noted under patient responsibility.

Are there any restrictions and/or limitations to my coverage?

Do I have coverage for out-of-network visits? How do I submit an out-of-network claim?