Reimbursement for Nutritional Counseling Services

In the last few years, our clients have had a much easier time getting our services covered by insurance when they have a prescription from their physician. Now that portions of the The Patient Protection and Affordable Care Act have gone into effect, coverage for preventive care is front and center. Here are the best suggestions for coverage:

Private Insurance 
Most health care providers should have no-cost preventive services included in their insurance plans. Ask your provider if they differentiate how much they will reimburse for preventive services in-network or out-of-network. Ask your provider to specify how they quantify in-network or out-of-network and how much they reimburse for out-of-network. Every provider has their own interpretation of this issue.

The following services we provide should be reimbursed 100 percent, with no co-pays, and no questions asked by your insurance provider, as long as you have a prescription from your physician that includes the correct diagnosis code(s) and the words "for medical nutrition therapy."

• Diet counseling for adults with higher risk for chronic disease
• Obesity counseling for all adults
• Folic acid supplements for women who may become pregnant
• Iron supplements for children ages 6 to 12 months at risk for anemia
• Obesity counseling for children

Each provider will have their own procedure and diagnosis codes that they will attribute to these services. You need to ask them or your physician for correct codes.

There are many more preventive services that we did not mention that will be covered partially or in full. Services with an "A" or "B" rating from the US Preventive Services Task Force are included. Here is a link to the full list.

Medicare
For our services, you would go through the same process as above. Then, you would submit the claim yourself to Medicare for reimbursement. In summary, Medicare is now covering counseling services for diabetes, preventive care or "wellness visit", and obesity only.

Every year, Medicare patients are allowed a free wellness visit up to $250. Part, or all of the visit, can be allocated for nutritional services if accompanied with a doctor's prescription with the words "wellness visit."

Disclaimer
As you know with insurance and Medicare, there are never any guarantees! These tips are just to give you the best chance for coverage.