Coding & Billing Handbook: A Guide for Program Directors and Preceptors

This guide is intended to assist registered dietitian nutritionists (RDNs), medical practitioners, practice managers, and billing personnel in the intricacies of submitting claims to private payers for medical nutrition therapy (MNT) in the context of a fee-for-service payment model; this is commonly referred to as reimbursement. It is not the only payment model used in healthcare payments, but it is the primary focus in this toolkit. Payment for the services provided by RDNs can also occur through Alternative Payment Models and Value Based Payments.

Coding & Billing Handbook

While some RDNs offering MNT services may choose to not bill private payers (private health insurance companies and other organizations), there may be many benefits to doing so. While submitting claims takes time and resources, it is one way to demonstrate consumer demand and use of MNT benefits purchased by employers, to increase RDN visibility as a provider to payers, and to support expanded opportunities for payment. Becoming credentialed with private payers is one way to increase referrals and one’s client base.

There are many consumers who have insurance benefits that include MNT/nutrition counseling, with opportunities continuing to grow as a result of the Patient Protection and Affordable Care Act (ACA), along with efforts by the dietetics profession and individual RDNs. However, there is no uniformity among or within health insurers regarding benefits, coverage terms, and billing policies. This manual is an update to a 2010 edition that was originally developed under a contract with the North Carolina Health and Wellness Trust Fund to support the efforts of RDNs, both in private practice and working in ambulatory settings, to create and implement a successful business model.

This manual includes some information that is available by searching documents and websites of various insurance providers, as well as information obtained through conversations with representatives from health insurers. We have sought to make this information as accurate and current as possible but cannot be held responsible if the information has changed. Health insurance plans, policies, and procedures change rapidly, and it is the responsibility of each provider to keep their information up to date.

• Section I provides instructions for obtaining a National Provider Identifier and becoming credentialed with insurers.
• Section II reviews MNT benefits and coverage, and reviews both Current Procedure Terminology (CPT®) codes and diagnostic codes (ICD-10).
• Section III details how to verify benefits and coverage, and what information the RDN should obtain from patients prior to the provision of services.
• Section IV provides the ins and outs of filing insurance claims.
• Section V provides a list of useful resources and website links (note: Links are active at time of publication 5/2022.