Insurance & Payment
Insurance Coverage for Nutrition Counseling in Connecticut
Medical insurance companies may or may not offer coverage for medical nutrition therapy. Investigate the type of plan/coverage you have.
Before your visit
Verify your plan and referral
If your insurance requires a referral, call your primary care physician and have them submit the referral for you BEFORE your visit.
Please call the toll free number on the back of your insurance card to confirm coverage, including the number of office visits covered per calendar year.
Our office will submit the necessary forms for you once coverage has been confirmed.
Before your visit
Check your coverage first
Romely participates with all the major insurance companies, but not all insurance plans cover nutrition counseling.
It is the patient's responsibility to call their insurance company PRIOR TO YOUR APPOINTMENT to review insurance plan benefits.
Call the 800 number on the back of your insurance card and speak with a representative to find out whether your insurance plan will cover your nutrition counseling visit. Most insurance companies do cover nutrition therapy, but you may not have met your deductible or have a copay or coinsurance.
Medicare covers only two diagnoses: diabetes and renal (kidney) disease. Nutrition counseling for pre-diabetes, obesity, or any other diagnosis is NOT covered by Medicare in an outpatient setting.
Coverage
Approved carriers include:
- Aetna
- Anthem Blue Cross and Blue Shield
- CarePartners of Connecticut
- Cigna
- Harvard Pilgrim Health Care
- Medicare
- Medicaid of Connecticut (Husky) Adults and Pediatrics
- Molina HealthCare
- United HealthCare
If your carrier isn't listed
If your insurance provider is not listed on this page, payment is due at the time the services are rendered. If there is any difficulty in making payment at the time of the visit, payment arrangements can be made with me at the time of your initial consultation.
Confidentiality
All information disclosed within sessions is confidential as written in the HIPAA notice of Privacy Practices.
HUSKY Health (Medicaid)
Medicaid of Connecticut (HUSKY) — Pediatrics and Adults
Pediatrics: almost all conditions for Medical Nutrition Therapy are reimbursable.
Adults: Medicaid covers patients with a BMI > 40 or a BMI > 35 with one or more chronic conditions such as coronary vascular disease, diabetes, hypertension, and metabolic syndrome.
When you call
Specific questions to ask your insurer
CPT codes
- 97802 (initial nutrition consult)
- 97803 (follow-up nutrition consults)
If you are told that you do not have coverage with the codes above, ask if the following codes are covered: 99401, 99402, 99403, 99404 or S9470.
Covered diagnoses
- Diagnosis code (ICD-10 code): Z71.3 (dietary counseling) or Z72.4 if they decline the first.
- Ask if other diagnoses are covered along with the above Z codes: pre-diabetes, diabetes, high cholesterol, hypertension, obesity or overweight.
Visits per year
- Please ask how many visits your plan covers per calendar year.
Note, your insurance may have cost-sharing due to either a co-insurance, co-pay, or deductible. You will not be charged for cost-sharing, if applicable, at the time of your visit. Rather, we will bill you after your claim has been processed to avoid confusion.
Questions about your coverage?
Call the office and we'll walk you through what to check with your carrier before your first visit.