Navigating insurance billing in your nutrition private practice can be confusing. Evolving legislation and coverage for telehealth services only further complicates the matter. Whether you are in-network with insurance companies or create superbills for your clients, it is beneficial to be well-acquainted with insurance billing codes. This will allow you to save time when creating CMS-1500 claims or Superbills and decrease the risk of claim denial.
We’ve compiled a list of insurance billing codes that every dietitian should know, including ICD 10 codes, CPT codes and G codes. Use this guide as a starting point to learning the billing process.
Here’s what you need to know about insurance billing codes for dietitians:
ICD-10 Diagnosis Codes
ICD stands for “International Classification of Diseases.“ These codes are used by physicians and medical coders to assign medical diagnoses to individual patients. Registered dietitians cannot make medical diagnoses. However, these codes are used on CMS 1500 forms, referrals, and superbills.
Common ICD-10 diagnosis codes you will see on referrals are:
- Z71.3 – Dietary counseling and surveillance (typically used for preventive services)
- E11.___ –Type 2 Diabetes (the ___ specifies if any complications are present)
- E66.0 – Obese due to excess calories
- E66.3 – Overweight (weight management referrals)
More information and a complete list of common ICD-10 codes was published by the Academy of Nutrition and Dietetics.
CPT, or Current Procedural Terminology, codes are the codes that identify the service you provided as a healthcare professional.
The three most common medical nutrition therapy (MNT) codes that dietitians use on claims are listed below. Public insurers, like Medicare and Medicaid, as well as private insurance carriers, can use these CPT codes.
- 97802 – For an initial assessment, face-to-face
- 97803 – For a follow up visit or reassessment, face-to-face
- 97804 – For a group visit (2 or more individuals)
When creating a superbill or filling out a CMS 1500 form, you will also have to specify the number of units and your fee per unit. Keep in mind, insurance billing is in units of 15 minutes each. This means a 1-hour initial assessment is 4 units. When billing for telehealth services, do not change your CPT codes. You are not changing the type of services offered, but rather the method of delivery. To note that you are billing for telehealth services, change your
Telehealth services are live, interactive audio and visual transmissions of a physician-patient encounter from one site to another using telecommunications technology. They may include transmissions of real-time telecommunications or those transmitted by store-and-forward technology.
The large insurance payers, including BCBS, United Healthcare, Cigna, Aetna, Humana, and Medicare all offer some form of coverage for telehealth services. However, despite the overwhelming benefits to providing telehealth care, insurance reimbursement and legislation in the United States is still in the nascent stage. Telehealth is typically still listed as a “policy-dependent” medical service, resulting in reimbursement that tends to vary from client-to-client, even if they have the same insurance provider.
First, you (or your client) should always check with the insurance company to evaluate coverage for virtual services. This can be done by contacting the insurance payer directly to confirm if telehealth nutrition services are a listed benefits for your client.
Billing for telehealth nutrition services may vary based on the insurance provider. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth.
Image above shows how to select the “Place of Service Code” when completing a CMS 1500 claim within Healthie, a practice management platform for nutrition professionals. Learn more about creating insurance claims through Healthie here.
Some other insurance payers, such as AETNA, may require you to also include a modifier code in your CMS 1500 claim when billing for telehealth. The two most commonly used modifiers for telehealth are:
- GQ – Asynchronous Telecommunications systems, such as a pre-recorded video
- GT – Interactive Audio and Video Telecommunications systems, including a live video conferencing session
- G0 – Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
- 95 – Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications system
For nutrition professionals, it is best practice to use modifier code 95, as it specifically created for Medical Nutrition Therapy (MNT) codes (97802, 89703, 97804). While modified code GT has essentially the same function, it was created for more general medical services. As a provider offering nutrition services, you are more likely to be reimbursed using code 95.
Many insurance companies are rapidly changing their coverage for telecommunications, so always perform an eligibility check before providing your services.
Most insurance companies limit the number of sessions covered per calendar year. If a client exhausts their benefits, and their referring physician determines a change in diagnosis that requires your service, you may find reimbursement using G codes to bill for the rest of the year.
The most common G codes are:
- G0270 – 15-minute one-on-one session for a reassessment due to a new or change in diagnosis
- G0271 – 30-minute group session for a reassessment due to a new or change in diagnosis
You can find out more about G codes here.
This is not a recommendation to use any of these codes for your documentation. Please ask insurance companies you are in-network with for the latest updates and preferences. Insurance billing varies from company to company and, state to state. This list is a glimpse at the frequently-used codes.
For more information on insurance billing and coding, please visit these resources:
- Insurance Credentialing and Contracting Guide for Dietitians: Webinar and Guide
- CMS Telehealth Services: Department Of Health And Human Services, Centers for Medicare & Medicaid Services
- Guide to Insurance and Reimbursement: Today’s Dietitian website
Charting and Billing Insurance Clients for Nutrition Services
As you get started with Insurance billing, it’s important to have the right tools in place. Running an insurance-based nutrition practice can be a rewarding and profitable business. Healthie’s HIPAA-compliant insurance billing features supports dietitians by minimizing time needed to create and monitor insurance claims, while also helping to ensure accurate claim submission to reduce claim rejections.
With Healthie, your insurance-baed business benefits by features designed for your practice, including:
- EHR with charting templates for nutrition professionals
- Automated electronic new client paperwork
- Easily collect and store client insurance information
- E Fax with ability to send and receive documents
- Store credit card information to charge or invoice for copays, deductibles, and other client owed responsibilities
- Create Superbills and CMS 1500 claims
- Easily send claims to Office Ally
- Billing reports to help you reconcile your insurance claims and received payments
Make more time to grow your business.
Use a platform that automates the administrative, so you can focus on growth and care.