Insurance Coverage for Nutrition Counseling

Feb 9, 2023

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There are 2 Types of Insurance Coverage for Nutrition Counseling: Medical Benefits and Preventative Coverage Benefits

Preventative Coverage Benefits: does not apply to Medicare (Medicare Advantage might be an exception), Tricare or some grandfathered private payer plans

The Preventive Health Services Act, as included in the ACA, requires that insurers provide no-cost coverage of nutrition counseling for Americans who are overweight and have at least one cardiovascular risk factor (hypertension, dyslipidemia, impaired fasting glucose/prediabetes, T2DM, Coronary Artery Disease, or Metabolic Syndrome). Coverage for nutrition counseling is best in this benefit category because it is covered at 100% of the allowed amount without deductible or copay required. Coverage usually depends on the provider’s network status.  You’ll get the best coverage from an in-network provider. If a plan has a network of providers, the plan is not required to provide coverage for recommended preventive services delivered by an out-of-network provider.  The plan may also impose cost-sharing requirements for recommended preventive services delivered by an out-of-network provider (ie only a portion of the cost is covered).

How many visits or units of service are covered under this preventive services requirement?

The regulations do not specify the frequency, method, treatment or setting for the provision of that service. Each payer and policy can set their own coverage criteria and limits on the amount of visits or units of service covered. So, as always, it is important to verify benefits before providing the service. See chart below for Preventative Care Coverage Policies for specific insurance companies.

Medicaid: Medicaid-eligible children under the age of 21 are provided coverage for preventive and comprehensive health services including nutrition counseling. 

Insurance Company Preventative Care Coverage Policy for Nutrition Counseling
Aetna Nutritional counseling is considered medically necessary for other chronic diseases in which dietary adjustment has a therapeutic role (eating disorders, gastrointestinal disorders, seizures, COPD, CKD, HTN, diabetes).

Preventative services for children or adults who are obese (BMI 30+)- (up to 26 nutrition counseling visits per calendar year covered at 100% 

Adults who are overweight (BMI 25+) AND have another cardiovascular risk factor (hypertension, dyslipidemia, impaired fasting glucose, T2DM, CAD, or metabolic syndrome)- (10 nutrition counseling visits per calendar year covered at 100%) when prescribed by a physician and furnished by a registered dietitian.  

Cigna/Midland’s Choice Preventative Care Services Policy:

Nutrition counseling is covered for adults who are overweight (BMI 25+) AND have 1 cardiovascular risk factor (hypertension, dyslipidemia, impaired fasting glucose/prediabetes, T2DM, CAD, or metabolic syndrome), or adults or children who are obese.

Visit limit: 3 per calendar year covered at 100%

UnitedHealthcare

UMR

Preventative Medicine & Screening Policy:

Medical Nutrition Therapy is recognized as a covered service for children or adults who are obese (BMI 30+) or overweight (BMI 25+) AND have 1 CVD risk factor (hypertension, dyslipidemia, impaired fasting glucose/prediabetes, T2DM, CAD, or metabolic syndrome)

Medicaid

  • UnitedHealthcare Community Plan
  • Nebraska Total Care
  • Healthy Blue
4+ nutrition counseling visits per calendar year covered at 100%
Medicare Medical Nutrition Therapy is covered for Diabetes and Renal Disease at 100% of the allowed amount.  Limited to 3 hours of one-on-one counseling per year

Referral is required. Additional nutrition counseling can be covered with an additional referral

Medicare Advantage plans might have coverage beyond traditional Medicare guidelines for additional visits or diagnosis, but referral is still required.

Medica Dietitian consultations are generally COVERED subject to the following: 

  1. Client is referred to a dietitian by a physician
  2. Services must be provided by a registered dietitian
Blue Cross Blue Shield of Nebraska Nutrition counseling is covered for adults who are overweight (BMI 25+) AND have 1 cardiovascular risk factor (hypertension, dyslipidemia, impaired fasting glucose/prediabetes, T2DM, CAD, or metabolic syndrome), or adults or children who are obese.

10+ nutrition counseling visits per calendar year covered at 100%. 

Telehealth currently only covered at 50%

Tricare Nutrition Counseling is covered with in-network providers but prior authorization is necessary to determine diagnosis and # of sessions covered

 

Companies with coverage policies for Nutrition Counseling could still have plans that state Nutrition Counseling as an exemption and therefore do not cover services, so the above table is not a guarantee that a specific plan will have the listed coverage.

These services may or may not be covered by all plans.  Refer to your plan for specific coverage information.

Medical Benefits (General Coverage Benefits)

If clients don’t qualify for preventative benefits, their plan still might have coverage for nutrition counseling. 

  • Insurance benefits often differ between in-network and out-of-network providers.
  • If they have a PPO plan, they are more likely to have a copay where insurance will cover a portion of the cost before they meet their deductible.  
  • Coinsurance is more often associated with High Deductible Plans and often doesn’t apply until they meet their deductible.  

Coverage Benefits for Medical Necessity

When MNT is important to the management or treatment of a condition, and it has been established that a patient has a benefit for MNT but a diagnosis(es) is not specifically covered or excluded under a patient’s individual plan benefits, opportunities for patient coverage and payment for MNT may be possible if it is determined that the MNT is medically necessary.  Oftentimes writing an appeal letter explaining reasons for medical necessity is effective.

2 Comments

  1. Christina rice

    Do you check with our insurance to make sure they cover it before initial meetings? Do you do virtual?

    Reply
    • Life Cycle Nutrition

      Hi! Yes, we have a medical billing specialist that checks individuals’ insurance coverage for nutrition counseling prior to their initial session. This is a free benefit, but please note there is no way for us to guaranty that the information given to us by the insurance company. Yes, we offer virtual sessions in select states (Nebraska, Iowa, California, Arizona, Michigan and California, but that will be expanding to more states by 2025).

      Reply

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