Insurance Diagnosis Restrictions / Special Instructions

Medicare and Medicare Advantage Plans
(MCR Aetna COV, MCR Allwell, MCR BCBS, MCR Cigna Healthspring, MCR Humana, MCR UHC)

Will only cover Diabetes and Renal Disease/CKD (Chronic Kidney Disease)

Patient must pay out of pocket for all other diagnoses (see Medicare Pricing for Non-Covered Diagnosis)

Ambetter

Will only cover Diabetes and Renal Disease/CKD (Chronic Kidney Disease)

Patient must pay out of pocket for all other diagnoses (see Self Pay Pricing) 

BCBS Kansas (does not include BCBS Kansas City or MCR BCBS plans)
Freedom Network
Multiplan/ PHCS

Patient must pay out of pocket (see Self Pay Pricing) but we will courtesy file. The patient will be refunded if their plan has coverage.

**If a patient knows they have dietary benefits with their particular plan, we will not need to collect at time of service but patient must sign the waiver and will be billed if their insurance does not cover the visit.

Tricare

Patient must pay out of pocket (see Self Pay Pricing)

We will not courtesy file Tricare.

Aetna
Cigna
HMCC Aetna
Humana
UHC

These plans have medical nutrition insurance coverage for certain diagnosis. Ok to schedule. Dietitian or assigned scheduler will contact patient if there are any restrictions.

BCBS Kansas City and out of state BCBS plans
(does not include MCR BCBS or BCBS Kansas plans)

Patient should check with their insurance plan to see if they have any of the following benefits: “Healthy Diet Counseling Program”, “Obesity Counseling Program” or “Diabetes Management Program”

**If a patient knows they have dietary benefits with their particular plan, we will not need to collect at time of service but patient must sign the waiver and will be billed if their insurance does not cover the visit.

Insurances not listed above

Treat as self-pay

**Gestational diabetes is considered diabetes for diabetic coverage listed above. Pre-diabetes is not covered as diabetes.

We will do our best to let you know your insurance coverage so you know your financial obligation prior to your visit with one of our dietitians.However, it is recommended that you contact your insurance carrier for your plan specific benefits.

Following is a breakdown of charges and self-pay rates, as well as typical time spent with the dietitian:

Visit Type CPT Code Charge to insurance (per 15 min) Insurance Charge per Typical Time Spent Typical Time Spent with a Dietitian Self-Pay Rate
(per 15 min)
Self-Pay Cost per Typical Time Spent
Initial Visit 97802 $59 $177 – $236 45 – 60 minutes $38.35 $115.05 – $153.40
Subsequent Visit 97803 $51 $102 – $153 30 – 45 minutes $33.15 $66.30 – $99.45

If you would like to verify MNT/dietitian coverage with your particular plan, call the customer service number listed on your insurance card. The information below may need to be provided when verifying coverage for Medical Nutrition Therapy.

NPI#: 1760798540

Tax ID#: 800505355

CPT codes: 97802, 97803

Diagnosis code(s) your provider has listed in your referral: If applicable, have your provider add a BMI code if your BMI is over 25. This can help with coverage of MNT visits for some of the insurance plans.

List codes:

After your first visit you will be given diagnosis codes that apply to the reason for dietitian visits from your functional medicine provider.

Medical nutrition therapy visits using Government Insurance Plans (Medicare and Tricare):

Medicare, Tricare (and Ambetter) patients do not have coverage to see the dietitian separately unless they have a diagnosis of Diabetes or Renal Disease (CKD stages 1-4).

If you desire to see a dietitian for a non-covered diagnosis, the following rates apply per time spent. Initial visit are 45-60 minutes and follow up visits are usually 30-45 minutes depending on the complication of each case.

Pricing summary for medical nutrition therapy

Medicare and Medicare Advantage plans pricing for non-covered diagnosis

Appt Length Initial Visit (97802 CPT Code) Subsequent Visits (97803 CPT Code)
15 minutes $35.60 $30.60
30 minutes $71.20 $61.20
45 minutes $106.30 $91.80
60 minutes $142.40 $122.40