If the insurance company asks for a CPT code please provide them with the following codes: 97802 & 97803. If they say you do not have coverage using those codes NEXT ask them to check your coverage for the following CPT codes: 99401, 99402, 99403 and 99404. We can also bill for S9470 if it is covered on your policy.

If the representative asks for a diagnosis code (aka ICD 10 code) – please tell them the visit code for the ICD 10 code: Z71.3.

If they don’t accept Z71.3 then provide them with Z72.4 and see if they will cover this diagnosis instead on your plan.

If you are medically considered overweight, have obesity, pre-diabetes, diabetes, hypertension, and/or high cholesterol you may want to see what your coverage is for these diagnoses as well.

Side Note: I always code your visit using preventive coding (if applicable) to maximize the number of visits you receive from your insurance carrier. However, if you ONLY have a medical diagnosis (for example: IBS, and you are not medically considered overweight, nor have CVD risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance.

HMO plans will require a referral from your Primary Care Provider. Often it will require a MD referral. Please check to see which type of professional must provide this documentation (MD, DO, ARNP).

Your representative will let you know how many visits they are willing to cover. Depending on the carrier the number of visits vary from Zero to unlimited depending on medical necessity.

A cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay, or co-insurance.

I will always bill under your insurance policy’s plan under your preventive benefits if your plan allows. With that being said, if you have preventive benefits there is often NO cost share for you associated with the visit. Once again, this is something YOU want to ask prior to your visit.

In the event you have a cost-share we will initially bill your insurance company directly. Once we receive the Explanation of Benefits (EOB) describing your responsibility as the patient, we will bill the credit card on file for the amount noted under “patient responsibility”.

For most insurance companies dietitians are considered a SPECIALIST. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card. However, often because we bill your insurance with preventative counseling the co-pay is often not applicable.

We generally wait for the claim to be processed to determine whether or not you have a co-pay and then charge the credit card you have on file with us the co-pay amount.

Please keep this for your records in case of discrepancies.