Monday, September 20, 2010

Reimbursement for Nutritional Counseling Services

We are a cash practice. The method in which our clients are reimbursed by insurance for our services is bringing a prescription with diagnosis code from their physicians. Now that most of the Affordable Care Act has gone into effect, coverage for preventive care is front and center. Here are the best suggestions for reimbursement:

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.

There are many more preventive services that we did not mention that will be covered partially or in full 
as long as you have a prescription from your physician that includes diagnosis code(s) and the words "for medical nutrition therapy." Services with an "A" or "B" rating from the US Preventive Services Task Force are included. Here is a link to the full list.


For our services, you would go through the same process as above. Then, you would submit the claim yourself to Medicare for reimbursement. Medicare is currently only covering counseling services for diabetes.

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

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