Wiki Nutritionist Billing

[coding4fun]

We are a multi-specialty practice (not under a hospital umbrella) who wishes to "contract" the services of a Nutritionist. I have researched the proper billing codes of 97802 & 97803 and fully understand that per Medicare these services cannot be paid "incident to" physician services. I am looking for guidance on how other family practice offices handle this type of billing. Short of having the patient sign an ABN for this service and making it a cash service, I am thinking that there is some other way of billing the carrier for this service and getting reimbursed. Any guidance which you guys can share would be greatly appreciated.

 

[thomas7331]

Medical nutrition therapy is a covered benefit for Medicare patients, so an ABN would not be an appropriate route for this since that is strictly for services that do not meet coverage guidelines or are not medically necessary. An ABN or waiver could be appropriate once the patient benefit maximum for this service has been reached, or in situations where the patient does not have coverage, but otherwise it should just be a matter of understanding your payer's requirements for appropriate billing.

I believe that the rationale for not allowing 'incident to' billing for this service is not because this is not covered, but rather that Medicare requires the dietician or nutrition specialist enroll and bill under their own credentials, and does not allow the dietician to bill under the physician's credentials. I think if your nutritions has proper credentials to enroll and bill, then you shouldn't have a problem getting payment for this. Novitas provides some good guidance on this for their jurisdiction (https://www.novitas-solutions.com/w...&showHeader=false&_adf.ctrl-state=xk6oraj7m_4), so you may wish to contact your local MAC and your commercial payers for their specific guidance on whether to credential this provider and how to bill. Hope this helps some.