Does Medicare Cover a Nutritionist?

Introduction

Does Medicare Cover a Nutritionist?

The short answer is yes, Medicare does cover a nutritionist, with restrictions. No surprise there, right? Medicare part B may cover some nutrition services. As long as they are provided by a registered dietitian (RD), registered dietitian nutritionist (RDN) or other Medicare approved nutritional professional.

The nutrition benefit provided to those with Medicare is known as Medical Nutrition Therapy (MNT). 

Keep reading to learn more about who is approved to provide MNT and what is involved in utilizing this valuable Medicare benefit.

And I mentioned restrictions, keep reading for those as well. Let’s dive into it.

Dietitian vs Nutritionist

So, what’s the difference? There are many. The biggest difference is that the education and training to become a dietitian is rigorous, evidenced based and standardized. A dietitian is a nutrition expert.

This may or may not be the case for someone that has studied to be a nutritionist.

Trone goes on to explain that dietitians “have specifically studied effective medical nutritional interventions to aid with the treatment and/or management of a disease.”

Another difference between a dietitian and a nutritionist is that a dietitian must maintain registration status. This is done by completing continuing education requirements on a regular basis. Got to keep the old brain sharp, ya know!

Who Can Bill Medical Nutrition Therapy?

There are some instances that Medicare will credential a “nutritional professional” that is not a dietitian, although this is rare.

Ultimately, if you want Medicare to pay the bill, then the only thing that matters is that you are seeing a dietitian or nutritional professional credentialed with Medicare.

Bottom Line: a dietitian can bill Medicare.

So, the answer to “does Medicare cover a nutritionist”– is yes, for some conditions when provided by a dietitian or other nutritional professional credentialed by Medicare.

To keep things simple, before your appointment be sure to make sure that the person you are seeing is either a Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN).

Either credential will work for billing purposes. So, what’s the difference? I’m glad you asked, keep reading, but first…

What is a Registered Dietitian Nutritionist?

Someone that really wants to help people. And someone that really likes science. Because there’s a lot of science to learn in order to become a dietitian.

Plus, you have to love reading really long research articles. There’s lots of those along the way. But that’s a great thing. Especially for patient care.

Bottom Line: most dietitians are research nerds.

But let’s take a look at the official stuff. For that, we will quote our colleagues at the “Academy.” The Academy of Nutrition and Dietetics (AND) is the official association for dietitians.

According to the Academy of Nutrition & Dietetics, “Registered Dietitian Nutritionists (RDNs) are food and nutrition experts who have met the following criteria to earn the RDN credential:

• Completed a minimum of a bachelor’s degree at a US regionally accredited university.
• Completed an ACEND-accredited supervised practice program at a health-care facility, community agency, or a foodservice corporation.
• Passed a national examination administered by the Commission on Dietetic Registration (CDR).
• Completed continuing professional educational requirements to maintain registration.” (Academy of Nutrition & Dietetics website)

Bottom Line: It’s not easy to become a dietitian.

What’s the difference between a Registered Dietitian Nutritionist and a Registered Dietitian?

Thank goodness. That’s an easy one to answer.

There is no difference between a Registered Dietitian Nutritionist (RDN) and a Registered Dietitian (RD).

Registered Dietitians may use the credential RD or RDN, there is no difference between the two credentials.

Well, then why are there two you might be wondering? Great question.

 Believe it or not, many people don’t associate dietitians as the go to person for general nutrition help.

In the past dietitians were usually only found in hospitals and nursing homes. So, most people associate us with the person that won’t let you have salt with your meal after open-heart surgery. (Not really true, but a story for another day). Or the person that makes sure you get a nutrition shake if you have a poor appetite, right?

Times are a changin’ though.

Today, more and more dietitians are working in doctor’s offices, outpatient clinics and in private practice.

In a world where many people are relying on health information on social media and google, it’s a great idea for everyone to establish a relationship with a primary care dietitian.

Even if this means considering a self-pay visit. Say what?

Or you could help me pass the MNT Act. More on that later.

Medical Nutrition Therapy

What is Medical Nutrition Therapy?

According to clinical dietitian Amy Plano, owner of The Reimbursement Dietitian, “Medical Nutrition Therapy (MNT) is a service provided by a Registered Dietitian (RD). It includes a comprehensive nutrition assessment followed by a detailed nutritional treatment plan consistent with an individual’s health goals. Depending on the outcome of the initial assessment, MNT may include follow up visits and subsequent evaluations.”

During all sessions the dietitian implements the Nutrition Care Process. According to Plano, “this process involves gathering important health-related information including a detailed medical and family history as well as the patient’s dietary patterns.” 

But that’s not all.

The dietitian may also collect additional information such as an individual’s weight, body composition and weight history. They will also evaluate any available lab results.

Depending on the individual’s medical history the dietitian may ask for permission to correspond with other pertinent members of the patient’s medical team. 

Wow! Practitioner’s that talk to one another! That’s a beautiful thing.

Whole Person Approach

The dietitian looks closely at the whole person. They will often ask about things such as stress, sleep, digestive, and elimination patterns.

Yep, as dietitians we are going to ask you about your poop! It really does matter. 

Depending on the complexity of issues the intake process (or information gathering stage) may vary from 10 minutes upward to an entire hour.

After the dietitian feels they have a sufficient amount of relative information they will then work directly with the patient to develop dietary interventions consistent with their food preferences.

Yes, as dietitians we care about the food that you like and don’t like. Healthy food doesn’t have to taste bad. I promise!

Nutrition Education vs Medical Nutrition Therapy

Medical nutrition therapy is more than just providing the client or patient nutrition education. After a complete assessment the dietitian will work to help you to create goals and action items.

Registered dietitians enjoy utilizing goal setting principles with their clients. By creating realistic, mutually agreed upon behavioral goals dietitians help keep their clients move forward and stay accountable. 

Goals and interventions are always personalized. They are consistent with an individual’s specific needs, their level of commitment level as well as their personal values. 

Dietitians assume a holistic approach when providing MNT. They do their very best to always be mindful and respectful of their client’s religious and cultural food preferences. 

In addition, when developing interventions dietitians take into consideration their client’s financial situation including any potential issues with food security.  

We understand that many of our Medicare clients are on fixed incomes. We know how to show you how to stretch your dollar. It doesn’t have to be expensive to eat healthy.

Listen to my podcast on Eating Healthy on a Budget.

Lastly, we assess the person’s ability to understand and participate in the intervention. We are really good at helping you translate all of that medical jargon into something that makes sense.

“Our goal is to meet our clients where THEY are and help them succeed in their desire to lead more healthful lives.”- Amy Plano, RD 

Your First Nutrition Visit

The first visit is the beginning of a relationship. For most people, good health doesn’t happen overnight.

Unfortunately, many people don’t end up in the dietitian’s office trying to prevent disease. They arrive with a disease and many years of poor diet and lifestyle choices.

It’s important to understand that changing a lifetime of poor eating habits doesn’t happen overnight.  

So, expect that your dietitian will want to see you for a follow up visit within two weeks of the initial consultation. After that a longer, mutually agreed upon follow-up plan will be designed. 

Laura Poland, RD, a private practice dietitian in Columbus, Ohio, and owner of Dietitian in Your Kitchen  helps me explain a visit with a dietitian. We talk about how a dietitian uses MNT during a visit.

We also talk about what happens during a visit for someone that wants to lose weight. Listen to the Medical Nutrition Therapy podcast.

Where is Medical Nutrition Therapy performed?

MNT has been traditionally performed by dietitians in the hospital, and long-term care & rehab centers. Also, in outpatient settings such as Diabetes, Dialysis and Metabolic Centers.

But there are lots of dietitians such as Amy and Laura that have private practices. Medicare allows telehealth visits which makes it so much easier for everyone. Especially with COVID-19 concerns.

There is a new trend toward including MNT in primary care medical offices. In the near future, it is likely that patients will have a primary care dietitian right in their doctor’s office. Wouldn’t that be convenient?

Examples of primary care dietitians in Florida include Urban Health & Orlando Family Physicians, where I work. My medical director at Urban Health, Dr. Jaime Gonzalez is a strong supporter of making good nutrition a priority.

My medical director at Orlando Family Physicians, Dr. Regina Marranzini is board certified in geriatrics and an advocate of using nutrition to prevent malnutrition in the elderly.

Listen to our Heart Health podcast.

The Villlage’s Health and some of the Orlando Health primary care offices also have dietitians on staff.

We are headed in the right direction. Ask your doctor to bring a dietitian to your office.

Nutrition matters. It’s time. Tell them that Medicare covers a nutritionist. A Registered Dietitian Nutritionist of course.

Medicare Medical Nutrition Therapy Coverage

Medicare covers three hours of MNT during the first year that a patient sees the dietitian. The three hours can be broken up into multiple visits of 15-minute increments.

Most dietitians will use 45-60 minutes for the first visit and then 15-30 minutes for the follow up visits. 

The second year and each year after that, Medicare will cover two hours of MNT. This can also be broken up into multiple visits.

Restrictions apply. Keep reading, we’re almost done.

Additional benefits may apply for a change in condition. This might happen for someone with diabetes that develops chronic kidney disease later on that same year. An additional referral is required. 

Does Medicare Require a Referral for Medical Nutritional Therapy?

Yes. Every year the patient will need to request a referral to a dietitian for MNT. The referral can be provided by a primary care physician (MD or DO) or physician specialist such as an endocrinologist. Unfortunately, a nurse practitioner cannot write the referral.

Your provider must determine that MNT is medically necessary. In my experience, most doctors are happy to write a referral. Who wouldn’t want someone to eat better?

Eligibility for MNT

What conditions does Medicare cover a nutritionist for? Currently, Medicare will only cover MNT for those diagnosed with Diabetes and Chronic Kidney Disease (Stage 3, Stage 4, Stage 5- not on dialysis). It will also cover it for someone that has had a kidney transplant within the past three years. 

Say what? Is that all? Frustrating, right?

Have no fear, we are hoping to change that very soon. Please keep reading.

We need your support. Your voice and your social media shares matter.

There is new legislation before Congress to expand the MNT benefit to include more medical conditions.

I will be covering the MNT Act in my next post.

Frequently Asked Questions

Will Medicare Cover a Nutritionist for Pre-Diabetes?

No. Medicare does not cover nutritional services (medical nutrition therapy) for pre-diabetes. Even if your doctor has told you to see a dietitian. 

A dietitian can be very helpful in helping someone get their blood sugar under control. Unfortunately, Medicare will not pay for the service. 

Some hospitals have diabetes program that are free or low cost but many of them closed during COVID-19.

You could see a dietitian privately on a self-pay cash basis. 

New York Presbyterian recently wrote an article about the new bill that would provide MNT coverage for pre-diabetes. It discusses why with COVID-19 the timing of getting this legislation passed is so critical.

Help us get it out of committee and to the House floor. Ask your congressional representative to support the MNT Act.

Will Medicare Cover a Nutritionist During Cancer Treatment?

Medicare currently does not cover a nutritionist or MNT for someone that is undergoing cancer treatment. Even though maintaining good nutritional status has been shown to improve outcomes.

However, many cancer treatment programs have staff dietitians that are available for patients. If you or a loved one is going through cancer treatment, ask if dietitian services are available.

Will Medicare Cover a Nutritionist for Someone with Unintentional Weight Loss?

No. Medicare does not cover a nutritionist or MNT for unintentional weight loss or malnutrition. This is quite unfortunate. It’s also one of the reasons that I started this blog.

As a dietitian, I often have to tell someone that really needs my help that I can only see them if they are able to pay for services. They are usually shocked that Medicare doesn’t cover it. For those on fixed incomes, paying for nutritional services can be a financial hardship.

Most hospitals will screen for malnutrition or unintentional weight loss and if found may provide a brief visit with the dietitian during the hospital stay.

Long term care facilities have dietitians on staff to monitor all patients, so insurance coverage is not an issue.

The MNT Act, if passed would cover medical nutrition therapy for malnutrition and unintentional weight loss. 

If you think that Medicare should cover more conditions, please reach out to your Congressional Representative. Ask them to support the MNT Act.

Does Medicare Cover a Nutritionist for Weight Loss Programs?

First, the person must have a BMI of 30 or greater. Next, the service that Medicare covers is not MNT. It is called Intensive Behavioral Therapy (IBT) and must be performed in an office with a physician on-site.

Some dietitians that work in outpatient clinics or primary care offices will perform this service. Medicare will cover one 15-minute visit weekly for four weeks and then every other week for 5 months. 

At the end of six months the patient will be evaluated for progress. A 6.6# weight loss is expected at the end of the six-month period. If this goal is met, the patient will receive one 15 minute follow up session each month for an additional 6 months. 

It is important to note that it is very difficult to design a custom weight loss plan after one 15-minute visit so most offices that offer IBT will require the patient to pay for an initial visit. 

There is new legislation before Congress to expand the MNT benefit.

Find a Registered Dietitian Nutritionist

How do I find a Dietitian?

Remember, that in order for Medicare to cover a nutritionist you should be searching for a Registered Dietitian Nutritionist. For starters, you can type “dietitian near me” in google for a quick list. You might get lucky. But, most likely some of these dietitians probably work at your local hospital so take a look at the address listed.

A great place to start is to ask at your doctor’s office. Your doctor may already offer nutritional services in their network or have an established relationship with a local dietitian.

Next, visit The Academy of Nutrition and Dietetics to find dietitians in your area.

Finally, you can also contact your local Medicare office directly to find a dietitian in your area.

Bookmark this page, The Medicare Nutritionist. Check back as we connect you with more dietitians that accept Medicare. We will also be offering other resources to help you get and stay healthy. Be sure to sign up for our email list.

Dietitians Accepting New Medicare Patients

For your convenience, I’ve including the contact information for myself and a few of my colleagues. I appreciate their help with making this page a useful resource. We are all credentialed with Medicare and are accepting new patients.

• Wendimere Reilly, RDN, LDN, Florida (Urban Health & Orlando Family Physicians)
• Amy Plano, RD, Connecticut
• Laura Poland, RD, Ohio
• Lucille Beseler, MS RDN & Team, Family Nutrition Center of South Florida

Conclusion

Will Medicare cover a nutritionist? Yes, for certain conditions, with a medical referral. The service is medical nutrition therapy. In most cases, it is provided by a Registered Dietitian Nutrition. In rare cases, other nutritional professionals can provide this service.

I hope you found this article helpful. Want to help? Yay, I hope so. Things you can do:

• Click on the blue button to send a letter to your congressional rep.
• Share this post with everyone you know.
• Talk to your doctor.
• Suggest they bring in a dietitian to the office. This makes accessing medical nutrition therapy easier.
• Call your congressional representative and ask them to support the MNT Act.
• If you are a dietitian and would like to help spread the word about the MNT Act, please connect with me.