Nutrition Balance

Insurance & Payment

Insurance Coverage for Nutrition Counseling in Connecticut

Medical insurance companies may or may not offer coverage for medical nutrition therapy. Investigate the type of plan/coverage you have.

Before your visit

Verify your plan and referral

If your insurance requires a referral, call your primary care physician and have them submit the referral for you BEFORE your visit.

Please call the toll free number on the back of your insurance card to confirm coverage, including the number of office visits covered per calendar year.

Our office will submit the necessary forms for you once coverage has been confirmed.

Romely Ritoli on the phone at her desk in the West Hartford office

Before your visit

Check your coverage first

Romely participates with all the major insurance companies, but not all insurance plans cover nutrition counseling.

It is the patient's responsibility to call their insurance company PRIOR TO YOUR APPOINTMENT to review insurance plan benefits.

Call the 800 number on the back of your insurance card and speak with a representative to find out whether your insurance plan will cover your nutrition counseling visit. Most insurance companies do cover nutrition therapy, but you may not have met your deductible or have a copay or coinsurance.

Medicare covers only two diagnoses: diabetes and renal (kidney) disease. Nutrition counseling for pre-diabetes, obesity, or any other diagnosis is NOT covered by Medicare in an outpatient setting.

Coverage

Approved carriers include:

  • Aetna
  • Anthem Blue Cross and Blue Shield
  • CarePartners of Connecticut
  • Cigna
  • Harvard Pilgrim Health Care
  • Medicare
  • Medicaid of Connecticut (Husky) Adults and Pediatrics
  • Molina HealthCare
  • United HealthCare

If your carrier isn't listed

If your insurance provider is not listed on this page, payment is due at the time the services are rendered. If there is any difficulty in making payment at the time of the visit, payment arrangements can be made with me at the time of your initial consultation.

Confidentiality

All information disclosed within sessions is confidential as written in the HIPAA notice of Privacy Practices.

HUSKY Health (Medicaid)

Medicaid of Connecticut (HUSKY) — Pediatrics and Adults

Pediatrics: almost all conditions for Medical Nutrition Therapy are reimbursable.

Adults: Medicaid covers patients with a BMI > 40 or a BMI > 35 with one or more chronic conditions such as coronary vascular disease, diabetes, hypertension, and metabolic syndrome.

When you call

Specific questions to ask your insurer

Your insurance company is billed directly for one-on-one session visits. Benefits are specific to your plan and diagnoses, so call the member number on the back of your card to confirm your coverage. Have the details below ready when you call.

Practice identifiers to give the representative

We are in-network with several plans, both as a group and individually. Ask your representative whether you have in-network coverage for your specific plan.

Tax ID number
06-1586093
Group NPI
1023200094
Individual NPI
1194930685

CPT codes

  • 97802 (initial nutrition consult)
  • 97803 (follow-up nutrition consults)

If you are told that you do not have coverage with the codes above, ask if the following codes are covered: 99401, 99402, 99403, 99404 or S9470. Also ask whether these codes apply to telehealth and/or in-person visits.

Cost & coverage

  • Do I have a copay, deductible, or coinsurance? If yes, ask whether it is for preventative care or Medical Nutrition Therapy — and if preventative, what you can be seen for.
  • Does my policy cover Medical Nutrition Therapy and/or nutrition counseling? Ask what procedure codes and conditions your policy covers.

Visits & renewal

  • How many visits are included in my plan? Ask what coverage you have for preventive versus medically necessary visits.
  • When does my plan renew? Some plans run January to December, others July to June — knowing this helps us schedule your appointments.

Referral

  • Do I need a referral? Most plans do not typically require one, but it is always a good idea to ask.
  • If a referral is needed, contact your primary care physician to have it faxed to our office at 860-310-1881.
  • Medicare always requires a referral, and covers visits only for diabetes and chronic renal failure — the same is true for supplemental insurance.

Note, your insurance may have cost-sharing due to either a co-insurance, co-pay, or deductible. You will not be charged for cost-sharing, if applicable, at the time of your visit. Rather, we will bill you after your claim has been processed to avoid confusion.

Potential coverage

Conditions and ICD-10 codes to reference

You can reference the conditions and diseases below for potential coverage. Ask your representative whether any of these diagnosis codes apply to your plan.

  • Nutrition counselingZ71.3
  • Obesity (BMI > 30)E66.9
  • Diabetes 2E11
  • Pre-diabetes (abnormal blood glucose)R73.09
  • HyperlipidemiaE78.5
  • GERDK21.0 / K21.9
  • HypertensionI10
  • PCOSE28.2
  • HypothyroidE03.8
  • Food allergyZ91.01
  • Overweight adolescentZ68.56
  • Crohn’s DiseaseK50.018
  • Celiac DiseaseK90.0
  • Pre-diabetesR73.03
  • UnderweightR63.6

Questions about your coverage?

Call the office and we'll walk you through what to check with your carrier before your first visit.

Call 860-781-9355Send a messageInsurance FAQs