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HealthPartners

Coverage criteria policies

Dietitian consultation

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for dietitian consultation.

Coverage

Dietitian consultation is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

  1. Consultations to teach diet modification for a newly diagnosed condition (e.g. diabetes, high blood pressure, pregnancy). A consultation is intended to assess and establish a program. Consultations are not intended for monitoring progress in programs, which are generally not covered by the health plan.
  2. Consultations for the management of chronic disease. HealthPartners considers nutritional counseling medically necessary for chronic disease states in which dietary adjustment has a therapeutic role, when it is prescribed by a physician and furnished by a registered dietitian recognized under the plan.”
  3. Consultations for dietitian services or evaluations for weight management when directed by a HealthPartners Plan physician or designee and furnished by a registered dietitian recognized under the plan. See Weight Loss Management coverage policy for further details.
  4. Consultations for covered weight loss surgery patients pre and post operatively.

Indications that are not covered

Dietitian consultation is not covered for any additional indication, including, but not limited to:

  1. Maintenance Consultation: Once the set goal has been reached, further services will generally not be covered because they are then considered maintenance.
  2. Individual Health Education: Not covered when group sessions (97804) are available for classes (at a nominal fee paid by the member) such as cholesterol reduction, etc., unless individual health education services are recommended by a HealthPartners Plan Provider due to certain situations such as language barriers, low literacy, access limitations, etc.
  3. Weight Reduction Monitoring: Individual visits with a dietitian for weight monitoring as part of weight reduction are not covered, except as described above for weight loss surgery patients.

Definitions

Dietitian consultation is part of a program of care initiated by a medical need to provide dietary assessment and counseling for proper management of an illness, disease process or disability.

If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

97802

Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with

the patient, each 15 minutes

97803

Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the

patient, each 15 minutes

97804

Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 01/01/1994 - Date of origin
  • 05/22/2017 - Effective date
Review date
  • 09/2015

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