A Simple Step-by-Step Guide to working with an Out-of-Network Dietitian
Thinking about working with an out-of-network dietitian? What many people don’t know that your insurance benefits can often cover sessions even if your dietitian is not in network with your insurance plan. This guide will walk you through using your benefits for nutrition counseling and will cover specific CPT codes (97803 & 97802) and the variability of covered diagnostic codes.
At Kate Brock Nutrition, we accept Aetna & Cigna (at the time of this blog, there may be more now so check the home page!) so if you are with another insurance company, this guide will be helpful for you! If you want to know how to check your insurance benefits for Aetna or Cigna – you can read how to do so here.
Understanding Benefits when working with an Out-of-Network dietitian
Step 1: Call Insurance to Verify Nutrition Counseling Coverage and CPT Codes
The first step is to contact your insurance provider to confirm coverage for nutrition counseling. You can use the number on the back of your card. Here’s a step by step on what to say:
“Hi, I am calling about verifying my insurance benefits. My provider will be using the following on my super bills to submit to insurance”
- CPT Codes: Relevant CPT codes for nutrition counseling include:
- 97802: Medical nutrition therapy; initial session (will be used 1x for initial session)
- 97803: Medical nutrition therapy; reassessment and intervention (will be used for all follow up sessions)
- Provider Information: Additionally, you might need your dietitian’s NPI (National Provider Identifier) number or EIN (Employer Identification Number) for verification. For reference, my individual NPI is 1841954070.
Step 2: Verify Covered ICD-10 Codes
After confirming the CPT codes, you will need to check specific ICD-10 codes:
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. Sometimes they require a BMI code in addition to Z71.3, so you could use Z68.24 as an example. So you would say, “do you cover Z71.3 by itself with those CPT codes?” If they say no, you can ask, what about Z71.3 plus Z68.24?”
If they say no and preventative coverage is not an option, then inquire about coverage for medical ICD-10 codes. Common ICD-10 codes include:
- E66.3 – Overweight
- E66.9 – Obesity
- E11.9 – Diabetes, Type 2
- F50.022 – Anorexia nervosa, binge eating/purging type, severe
- F50.012 – Anorexia nervosa, restricting type, severe
- F50.20 Bulimia nervosa, unspecified
- F50.810 Binge eating disorder, mild
- K58.9, IBS
For more eating disorder codes that are billable – please check out this post.
Note: Although I don’t use BMI or weight as health markers in my practice, these codes assist with reimbursement.
Note: You may have a deductible that you have to reach before anything is covered, so make sure you ask about this as well!
Step 3: Contact Your Doctor’s Office to ask about ICD-10 codes your dietitian will use
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?” If they don’t have the one that you checked from your insurance on file, book an appointment with them to get that code or similar code on file.
For example, if you have been seen for binge eating in the past, but never received a formal diagnoses you could say to your doctor, “I am looking to see a dietitian for my binge eating, could you evaluate me for binge eating disorder?” If you are diagnosed with binge eating disorder, then you can get that code from your doctor to use for nutrition counseling.
This does NOT work for getting a new diagnosis for something you do not have just to have insurance cover it, you must have active symptoms.
For eating disorders, you may also contact your therapist for an ICD-10 code.
Step 4: Schedule Your Initial Appointment with your Out-of-Network Dietitian and Obtain a Superbill from your dietitian
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 5: 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.
Please note that we do not contact insurance companies that we are not in network with. We are currently out of network with all insurance companies except Aetna & Cigna.
Ready to get started? Book a free call here.