Frequently Asked Questions
Do I need to fill out paperwork before my appointment?
Yes, you will be asked to fill out some paperwork before you arrive for your appointment. For your convenience, we will mail them to you and we have also made these forms available online. You may print and bring the completed forms with you to your appointment.
How much is the class session?
- That depends on your insurance plan and what type of education you get
- You will be billed the difference for what the insurance company doesn’t cover
- Remember you have to meet your deductible first
Does my insurance cover diabetes education?
- We cannot know how much your insurance will over since there are so many different plans
- Generally, most insurance companies cover a least a portion up to 100% of diabetes self-management education (DSME)
- Call the 1-800 number on the back of your insurance card to find out
- Medicare and Medicaid also covers at least a portion of diabetes self-management education (DSME)
Does my insurance cover nutrition education?
- Many health insurance companies cover medical nutrition therapy based on your diagnosis.
- To find out if your health insurance covers nutrition, please call the 800 number on your insurance card. Questions to ask your insurance company are below.
- Coverage for nutrition counseling is a flat fee of $50 for an individual, one-hour session. Follow-up sessions are based on how long your appointment lasts and vary in cost.
- If insurance pre-authorization if required, your doctor’s office is responsible to obtain it.
- If you have Medicare, please note that Medicare only covers nutrition counseling for individuals who are diagnosed with type 1 or type 2 diabetes, obesity or end-stage renal disease.
When calling your insurance company, ask the following questions:
- Does my plan cover outpatient diabetes education? If yes, how many sessions are allowed?
- Does my plan cover outpatient nutrition counseling? If yes, how many sessions are allowed?
- Do I have to a deductible to meet first?
- What is my co-pay amount for outpatient nutrition counseling? (NOTE: co-pay may be different than what is listed on your card since it may be considered as a “specialist”.
- When talking with your insurance company about diabetes classes, use the term Diabetes Self-Management Education (DSME)
Do we bill for facility or provider?
- We do not bill as a provider. The insurance company gets a bill from the facility where you had your education session.
- We bill as an education class.
- Most insurance companies, Medicare & Medicaid included, provide coverage for diabetes education. To check your insurance coverage, please call your insurance company before your appointment. If your insurance requires pre-authorization, this must be done by your physician's office.
Which CPT codes are used?
- 97802 – Medical Nutrition Individual
- 87804 – Medical Nutrition Group
- G0108 – Diabetes Management Training per individual
- G0109 – Diabetes Management Training per IND/Group
How do I find out if the physician is in my insurance’s network?
- You would need to look that information up on your insurance website