Important Changes to Highmark's Medical Nutrition Therapy Policy

Following recent discussions between the Academy and Highmark, the following outlines important changes to Highmark’s Medical Nutrition Therapy (MNT) benefits.

Beginning in August 2026, Highmark will implement a 5-hour annual cap on MNT visits. Through their recent audit activity, Highmark has identified a notable increase in the volume of MNT visits that was not consistently associated with measurable improvements in patient outcomes.

Changes to the policy include:

• Highmark members will have 5 hours available beginning in August 2026 regardless of prior utilization.
• Each subsequent benefit period moving forward Highmark members will have 5 hours of MNT available.

For patients who require additional MNT services beyond the 5-hour cap:

• A prior authorization (PA) request may be submitted.
• While RDNs may initiate this process, we strongly recommend that supporting documentation from the diagnosing provider (e.g., PCP or specialist) be included to substantiate medical necessity.
• Please be aware that initial PA requests will be denied by default, in accordance with current policy. The provider will need to complete a peer-to-peer consultation to override the current policy Quantity Level Limits (QLL).
• Only one peer-to-peer consultation is permitted. If the RDN conducts the consultation, another provider (PCP or specialist) will not be able to request an additional review.

Highmark has indicated that this process is not intended to create barriers, but rather to ensure that care provided is medically necessary and appropriately aligned with patient needs.

The Academy and Highmark also continue to engage in ongoing discussions regarding the appropriate number of MNT visits. Highmark has expressed openness to reviewing evidence-based literature that may support the need for additional visit allowances, and we will continue to advocate on behalf of RDNs and their patients as these discussions progress.

If you believe that medically necessary care is being denied, we encourage you to contact the Academy's advocacy team so that we can monitor trends and engage as appropriate.