Before your appointment, it is your responsibility as the patient to contact your insurance company and confirm your nutrition counseling benefits.

Insurance coverage varies widely by plan, diagnosis, and benefit structure. Verifying your benefits in advance helps prevent unexpected charges or denied claims. While we are happy to assist with general billing questions as a courtesy, final responsibility for understanding your coverage rests with the patient.

Questions To Ask When Calling Your Insurance Company

1. Do I Have Coverage For Nutrition Counseling?

Ask whether your insurance plan includes coverage for nutrition counseling with a Registered Dietitian (RD/RDN).

If the insurance representative requests CPT (procedure) codes, provide:

• 97802 – Initial nutrition assessment

• 97803 – Follow-up nutrition counseling

If those codes are not covered, ask them to check coverage for the following CPT codes:

• 99401

• 99402

• 99403

• 99404

• S9470 (if applicable under your plan)

Coverage may differ based on how services are categorized, so it is important to ask about all applicable codes.

2. Are My Diagnoses Covered Under My Plan?

If your insurance representative requests a diagnosis code (ICD-10), you may provide:

• Z71.3 – Dietary counseling and surveillance

If this diagnosis code is not accepted, ask whether coverage is available under:

• Z72.4 – Inappropriate diet and eating habits

You may also want to ask about coverage related to the following diagnoses, if applicable:

• Overweight or Obesity

• Prediabetes or Diabetes

• Hypertension

• High Cholesterol

• Cardiovascular or Metabolic Risk Factors

When possible, visits are billed using preventive counseling codes to help maximize the number of visits available under your plan. However, if your visit is associated only with a medical diagnosis (for example, IBS without cardiometabolic risk factors), your insurance plan may apply a cost-share, such as a deductible, copay, or coinsurance.

3. How Many Nutrition Visits Are Covered Per Calendar Year?

Ask how many nutrition counseling visits your plan covers per calendar year.

Depending on the insurance carrier and plan design, coverage may range from zero visits to unlimited visits, based on medical necessity.

4. Do I Have A Cost-Share For Nutrition Counseling?

A cost-share is the portion of the visit you are responsible for paying and may include:

• Deductible

• Copay

• Coinsurance

When permitted by your insurance plan, we will submit claims using preventive nutrition counseling benefits, which often results in no cost-share. However, this is not guaranteed and must be confirmed directly with your insurance provider prior to your appointment.

If a cost-share applies:

• We bill your insurance company first

• Once the claim is processed and we receive the Explanation of Benefits (EOB), the amount listed under patient responsibility will be charged to the credit card on file

5. Are Registered Dietitians Considered A Specialist Under My Plan?

Many insurance companies classify Registered Dietitians as specialists, which may mean a specialist copay applies. This information is often printed on the front of your insurance card.

That said, when services are billed under preventive counseling benefits, specialist copays are often not applicable. Because this varies by plan, we generally wait until the insurance claim has been fully processed before determining whether a copay applies.

If a copay or coinsurance is required, the applicable amount will be charged to the card on file after the EOB is received.

6. Is Telehealth Covered The Same As In-Person Visits?

Ask whether your insurance plan covers telehealth nutrition visits, and whether there is any difference in coverage or cost compared to in-person appointments.

Good Faith Estimate (Self-Pay & Uninsured Clients)

If you are uninsured or choose to self-pay (including clients who elect not to use insurance), you have the right to receive a Good Faith Estimate (GFE) of expected charges under the No Surprises Act.

A Good Faith Estimate includes:

• The anticipated cost of scheduled services

• Any additional expected charges related to your care

• The timeframe covered by the estimate

Please note:

• A GFE is an estimate, not a guarantee of final charges

• Actual charges may vary based on services provided

If your final bill exceeds your Good Faith Estimate by $400 or more, you have the right to dispute the bill.

To request a Good Faith Estimate, please contact us before scheduling your appointment.

Summary: Questions To Confirm Before Your Visit

• Do I have coverage for nutrition counseling?

• Do I need a referral to see a Registered Dietitian?

• Are my diagnoses covered under my plan?

• How many visits are covered per calendar year?

• Do I have a deductible, copay, or coinsurance?

• Is telehealth covered the same as in-person visits?

Questions Or Need Help?

If you have questions after verifying your benefits or would like to request a Good Faith Estimate, we’re happy to help.

📧 Email: support@newlifenutritionwellness.com