Many people wonder, is nutrition covered by insurance, even if my nutritionist is out of network? We’re here to help answer that question.
At Plenish, we are in network with CareFirst, Aetna, Cigna and United Healthcare. Most of our clients pay $0 for appointments since we are in network with these major insurances! However, if you are with a company that we are not in network with, like Tricare, you may still be eligible for nutrition covered by insurance.
Understanding how your benefits work can make nutrition counseling more affordable and help you get the support you need. This guide walks you through the basic steps, including the common CPT codes (97802 and 97803) and how to check whether your diagnosis codes are eligible for reimbursement.
Many of our clients have received reimbursement for anywhere from 50%-100% of the appointment cost when submitting a super bill from insurance companies like Tricare.
How to Use Out-of-Network Benefits for Nutrition Covered by Insurance via Reimbursement
Step 1: Look Over Your Insurance Policy
Start by reviewing your plan’s details. You’re looking for information about:
• whether nutrition counseling is included
• how out-of-network reimbursement works
• your deductible and any co-insurance
• coverage limits or visit caps
Sometimes these details are hard to find. It’s completely normal to call the number on the back of your card to have a representative walk you through it.
Step 2: Ask About Coverage for Nutrition Counseling (CPT Codes)
When you call, ask specifically whether your plan covers nutrition counseling with the following CPT codes:
97802 — initial nutrition assessment, individual (15 minutes)
97803 — follow-up/reassessment sessions, individual (15 minutes)
The insurance representative may also ask for your dietitian’s NPI or EIN. For clients working with us, our group NPI is 1629804943
Step 3: Confirm Which Diagnosis Codes Are Covered
Coverage often depends on the ICD-10 diagnosis code attached to your claim.
First, start by asking about preventative nutrition counseling using Z71.3. If your plan covers it, they may allow a certain number of sessions per year. Some plans also require a BMI-related code alongside Z71.3, so it’s helpful to check. Additionally, you could test something like Z71.3 with Z68.24 to see if that would be covered.
If preventative coverage isn’t available, ask whether they cover nutrition counseling for medical conditions. Common ICD-10 codes include:
• E66.3 / E66.9 — overweight or obesity
• R73.03 — prediabetes
• E11.9 — type 2 diabetes
• E78.1 — high cholesterol
• I10 — hypertension
• F50.00, F50.2, F50.81, F50.9 — eating disorders
• K58.9 — IBS
• K50.90 / K51.90 — Crohn’s or ulcerative colitis
• K90.0 — celiac disease
• Z71.3 — dietary counseling and surveillance
Note: While insurance requires weight-based codes for coverage, Plenish providers do not use weight as a measure of health in clinical practice.
Next, Call your doctors office
Step 4: Call Your Doctor’s Office
Your doctor may already have ICD-10 codes on file for you. You can use this simple script:
“I’m planning to work with an out-of-network dietitian and need the ICD-10 codes you have on file for me. Could you share that documentation?”
Step 5: Schedule Your Session and Request a Superbill
Once you’re ready, book an appointment with your dietitian. After your visit, your provider can give you a superbill. This document outlines your services and is mandatory for insurance reimbursement.
Step 6: Submit Your Claim
Send the superbill to your insurance company following their submission instructions. It’s helpful to keep copies of everything you send in case you need to reference them later.
Finally, you can book an appointment with your nutritionist!
Ready to work with a Plenish Nutritionist? Meet our team & book a free call here.
