The Ultimate Guide to Working With An Out-Of-Network Dietitian

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A Simple Step-by-Step Guide

Nutrition counseling plays a crucial role in maintaining overall health and well-being. You might not realize, however, that your insurance benefits can often cover sessions with an out of network dietitian. This guide will walk you through using your benefits for nutrition counseling and will cover specific CPT codes (97803 and 97802) and the variability of covered diagnostic codes.

Understanding out-of-Network Benefits

Step 1: Review Your Insurance Policy

To start, thoroughly examine your insurance policy. Pay particular attention to the following:

Coverage Limits: Determine what portion of out-of-network nutrition counseling your insurance covers.
Reimbursement Rates: Find out how much reimbursement you will receive.
Deductibles and Co-Pays: Identify any out-of-pocket expenses you might incur.

In addition, look for details specifically related to out-of-network benefits for nutritional services.

Step 2: Verify Nutrition Counseling Coverage and CPT Codes

Once you have reviewed your policy, contact your insurance provider to confirm coverage for nutrition counseling. Specifically, inquire about the following:

CPT Codes: Relevant CPT codes for nutrition counseling include:
- 97803: Medical nutrition therapy; reassessment and intervention, individual, face-to-face with the patient, each 15 minutes.
- 97802: Medical nutrition therapy; initial assessment, individual, face-to-face with the patient, each 15 minutes.
Provider Information: Additionally, you might need your dietitian’s NPI (National Provider Identifier) number or EIN (Employer Identification Number) for verification. For reference, my NPI number is 874718767.

Step 3: Verify Covered ICD-10 Codes

After confirming the CPT codes, check if your insurance covers the relevant ICD-10 codes for your condition.

First, ask if your insurance covers preventative nutrition using code Z71.3. If they do, find out how many sessions they cover, which typically ranges from 3 to 10 sessions.

If preventative coverage is not an option, then inquire about coverage for medical ICD-10 codes. Common ICD-10 codes include:

Overweight (E66.3) / Obesity (E66.9)
Pre-diabetes (R73.03)
Diabetes, Type 2 (E11.9)
High Cholesterol (E78.1)
High Blood Pressure (I10)
Eating Disorder, Anorexia Nervosa (F50.00)
Eating Disorder, Bulimia (F50.2)
Eating Disorder, Binge Eating (F50.81)
Eating Disorder, Other (F50.9)
IBS (K58.9)
IBD, Ulcerative Colitis (K51.90)
IBD, Crohn’s (K50.90)
Celiac Disease (K90.0)
Dietary Surveillance (Z71.3)

Note: Although I don’t use BMI or weight as health markers in my practice, these codes assist with reimbursement.

Step 4: Contact Your Doctor’s Office

Next, use this script: “I am looking to work with an out of network dietitian and need to know which ICD-10 codes you have on file for me. Could you please provide me with this documentation?”

Step 5: Schedule Your Initial Appointment and Obtain a Superbill

After contacting your doctor’s office, book an appointment with the dietitian of your choice. At the end of your session or billing period, ensure you receive a superbill from your provider. The superbill details the services provided and associated costs, which you will need for insurance reimbursement.

Step 6: Submit a Claim to Your Insurance Company

Finally, submit the superbill and any required documentation to your insurance company for reimbursement. Adhere to your insurance provider’s claim submission process carefully and keep copies of all documents for your records.

I am currently out of network with every insurance company except Aetna.

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