Verifying Insurance

To verify insurance, please feel free to use the following script:

 

Hello! I am calling for an eligibility check to verify the services that my health insurance covers. I would like to check to see whether my plan covers nutrition counseling services and any additional diagnosis codes. I have the following questions: 

  • Confirm policy type: This refers to the patient’s type of health insurance policy. There can be many different types of policies:

    • Medicare Part B

    • Medicare Advantage (Medicare Part C)

    • Medicaid or CHIP

    • Commercial

    • Other or additional information (PPO, HMO, EPO or others)

  • Confirm benefit period: Confirm that the client’s insurance policy is active. Note the benefit period, the length of time during which a benefit is paid, and the future termination date. Often this benefit period is the same as the calendar year (January 1 – December 31), but in some cases the benefit period differs. It is important to pay attention to the benefit period, especially regarding the number of visits/benefit period and if/when clients have deductibles.

    • Benefit period (plan year) and future termination date:​ ___________

  1. Do I have nutrition counseling / MNT coverage on my insurance plan? Y/N​

    • Does the member have a benefit for Nutrition Counseling/Medical Nutrition Therapy? Y / N

    • Indicate CPT® codes (e.g., 97802 and 97803, or 97804) for MNT/nutrition counseling. _________________________

    • Established diagnosis(es)/ICD10s covered*: _______________________________________________

    • Comments/instructions regarding correct use of codes(s) or combination for claims:

    • Exclusions (related to the MNT benefit):

    • If the insurance company asks for a CPT code, please provide them with the following CPT codes: 97802 and 97803. 

      • ​97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to- face with the patient, each 15 minutes.

      • 97803: reassessment and intervention, individual, face-to-face with the patient, each 15 minutes.

      • 97804: group (2 or more individual(s)), each 30 minutes.

    • Some payers will require a second referral and the use of these G codes when additional hours of MNT services beyond the number of hours in the standard benefit are indicated.

      • G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen, each 15 minutes.

      • G0271: group (2 or more individual(s)), each 30 minutes.

    • Additional Codes Recognized by Medicare:

      • RDNs may be qualified to provide the following services under Medicare; these codes may also be recognized by some private payers. Refer to individual payer policies for use of code and specific coverage parameters.

      • G0438-39: Annual Wellness Visit