QUESTIONS TO ASK YOUR INSURANCE COMPANY:
Call the member services number on the back of your insurance card and ask the questions below:
1. Does my plan cover outpatient nutrition counseling? CPT codes 97802, 97803)
If YES, how many sessions are allowed?
Does my plan only cover visits that are "medically necessary"? Does it also cover preventative services?
Does my plan cover telehealth/virtual visits for nutrition counseling?
*Paradigm Nutrition only offers virtual/telehealth appointments at this time
If you do not have coverage with the CPT codes listed above, ask about CPT codes: 99401, 99402, 99403, and 99404.
2. Is there a deductible to be met first?
If YES, how much is the deductible?
How much of the deductible has already been met?
3. Do I have a copay for outpatient nutrition counseling?
4. Do I need to have a physician referral?
5. How many visits do I have per year?
Depending on your insurance & coverage, the number of visits may vary from 0 to unlimited.
6. Will my diagnosis be covered?
If the insurance asks for a diagnosis code, ask about these codes: Z71.3 or Z72.4
If you have an eating disorder, ask the insurance about your specific eating disorder diagnosis code, along with Z71.3 and Z72.4:
- Anorexia, restricting type: F50.01
- Anorexia, binge eating/purging type: F50.02
- Bulimia: F50.2
- OSFED (atypical anorexia or bulimia): F50.89
- ARFID (avoidant/restrictive food intake disorder): F50.82
- Binge eating disorder: F50.81
Important Notes
Make sure to record the representative’s name and reference number when asking about your benefits. This information will be necessary should you ever need to dispute a rejected claim.
**Please note that if your insurance denies coverage for nutrition counseling sessions with Paradigm Nutrition, you will be 100% responsible for the payment.