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Medicare pays for many preventive services in order to aid you in staying healthy. Preventive services can find problems early and can help keep you from getting certain diseases or illnesses. These services include exams, lab tests, and screenings. One of these services is nutrition therapy.
What is Medical Nutrition Therapy?
Medical Nutrition Therapy is the development of a specific dietary plan of action. It is used for the treatment of an illness, injury or disease condition. Nutrition and diet are an important part of health management for people with diabetes or renal diseases.
The nutrition plan is based on an evaluation of a person's medical history, psychosocial history, physical examination, and dietary history.
- Medical History – A medical history includes a summary of diseases and conditions. It also includes a review of medications. This is included because medications may interfere with nutrient absorption. Vitamins, minerals, and herbal supplementation can also affect nutritional balance.
- Psychosocial History – A psychosocial history includes a review of a person's economic status, ethnic and cultural background, living situation, education level, occupation, mental status, and access to adequate food sources. Each of these items is important in order to determine a person's ability to follow through on specific therapy plans.
- Physical Examination - A physical examination includes an assessment of sex, age, height, weight, body mass index, and arm or wrist circumference. It may also include the physical appearance of the hair, skin, and nails. All of this information together can determine nutritional problems.
- Dietary History - A dietary history is just a listing of a person's usual food intake. Any of the following methods can be used to determine this information: a food frequency questionnaire, a twenty-four-hour recall of food eaten, or a three-day to five-day food diary. This information is an important starting point for any nutritional plan.
Does Medicare Cover Medical Nutrition Therapy?
Medicare Part B covers medical nutrition therapy service for people with diabetes or renal disease. There are several parts to this benefit:
- A review of nutrition and lifestyle
- Nutrition counseling
- Information on how to manage lifestyle factors that affect diet
- Follow-up visits to monitor the progress of diet management
The first year you are diagnosed, , Medicare covers three hours of one-on-one counseling services. For each subsequent year, Medicare covers two hours of one-on-one counseling services. If your condition, treatment, or diagnosis changes, you may be able to get more counseling. You must have a doctor referral for all counseling services. If treatment is needed into the next calendar year, a new referral is needed. Medicare also covers counseling services by telephone, computer, etc.
Medicare also covers other services for people with diabetes, including diabetes self-management training. People with diabetes may receive both medical nutrition therapy and diabetes self-management training in the same year. Each service requires a separate referral from your physician (or qualified medical personnel). Medical evidence suggests that diabetes self-management training should be completed before medical nutrition therapy services.
Do I Qualify for Medical Nutrition Therapy?
All Medicare beneficiaries who have diabetes or renal disease are covered for medical nutrition therapy. This includes people who have kidney disease but aren't on dialysis or haven't had a kidney transplant. Medicare also covers nutrition therapy up to three years after a kidney transplant.
Your primary care physician must make a referral to a registered dietitian (or qualified personnel) for therapy. This referral is required as proof of medical necessity for nutrition therapy services.
What Do I Pay?
People with Original Medicare pay 20% of the Medicare-approved amount for nutrition diet therapy. The Part B deductible must be paid first.
If you get your coverage from a Medicare Advantage plan, you will have to check your plan to find out how much you will have to pay.
How Do I Find a Provider for Medical Nutrition Therapy?
Always start by asking your doctor for recommendations. If you get your coverage from a Medicare Advantage plan, you may have to use one of the providers that they have on contract. A registered dietitian or Medicare-approved nutrition professional can provide these services. Registered dietitians are employed in settings such as hospitals, health clinics, extended-care facilities, physician offices, etc.
If you are covered by Original Medicare, make sure you do your homework before choosing a provider. Ask the provider/supplier:
- If they are participating providers/suppliers
- If they accept assignment
- To write down what they will charge and how much of it you will have to pay
If your provider/supplier does not accept assignment:
- You may have to pay more than the Medicare-approved amount.
- You may have to pay the entire cost of the services at the time they are rendered.
- You may have to bill Medicare yourself and wait several weeks before you will be reimbursed.
If the registered dietitian (or nutrition professional) is not enrolled in Medicare, then Medicare will not pay for those services.