Want to use your health insurance benefits for nutrition services?
Great news! In recent years as a result of the Affordable Care Act, nutrition services are often a covered benefit with many insurance companies. Some policies will only cover nutrition counseling if you have been diagnosed with certain medical conditions, while other policies may cover nutrition counseling for prevention. These can be referred to as preventative benefits. Insurance can be confusing, so I created a form you can use when calling your insurance company to ask about coverage of nutrition services. The form contains all the questions you’ll need to ask! Download below.
Read the FAQ below to learn more
What insurance companies are you in-network with?
At this time I am in-network with UHA (University Health Alliance), HMSA, HMAA (Hawaii Medical Assurance Association) and Medicare.
How do I know if my insurance policy covers nutrition counseling services?
We recommend calling the 800 number on the back of your insurance card and asking them the following questions:
Are nutrition counseling services covered under my policy?
If they ask you for a CPT code, provide them with the following codes: 97802 & 97803. If they tell you that you do not have coverage for those codes, ask them to check your coverage for the following CPT codes: 99401, 99402, 99403 and 99404.
Does my policy cover nutrition services for the following ICD-10 codes: Z71.3 and/or Z72.4. If they say, “no,” ask them what diagnosis codes are covered.
How many visits are covered per calendar year?
Is a physician referral required?
Have I met my deductible? In the event you have not met your deductible, you will pay out of pocket for nutrition services and this amount will then be applied towards your deductible.
Do I have a copay for nutrition services? Nutrition is considered a specialty, so typically the specialist copay is applicable to your visit.
If needed, please download the referral form below and have your doctor’s office fax to us at 844-640-0743
What if I have a high deductible health insurance plan?
If you have a high deductible plan, you will pay out of pocket for nutrition counseling at the time of service. This amount will be applied to your deductible.
What if you are not in-network with my insurance company?
In the event we are not in-network with your insurance company, you can call your insurance and ask them if you have any out-of-network benefits for nutrition services. You will pay out of pocket for nutrition counseling at the time of service. We will provide you with an itemized healthcare receipt called a “superbill,” which you can use to file a claim with your insurance company for possible reimbursement. Reimbursement is not guaranteed and will depend on your policy and whether or not you have any out-of-network benefits.
- Medicare ONLY covers nutrition counseling services if you have a diagnosis of Type 1 Diabetes, Type 2 Diabetes or Renal/Kidney Disease.
- Nutrition services for the above conditions are covered at 100%, meaning you will have no out of pocket cost!
- Medicare requires a referral from a Physician (MD/DO) in order to cover nutrition services. They will not accept any referrals from a Nurse Practitioner (ARNP) or Physician Assistant (PA).
- If you are seeking nutrition services for a condition OTHER than the above covered diagnoses (Diabetes or Renal/Kidney Disease) and you have Medicare AND a supplemental insurance policy OR a Medicare Advantage plan, it is possible nutrition services are covered. We can help you verify these benefits. You will still need a referral from your physician.
- Please download our Referral Form below and have your physician fax it to us at 844-640-0743
Have more questions?
Email us your questions about verifying health insurance benefits at firstname.lastname@example.org OR call at 352-284-8244. If needed, we can assist you with the process.