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Nutrition benefits verification checklist

By Javier Alvarez · Updated September 29, 2026 · 5 min read

Use this page before every new insurance patient. It's one printable page with nothing to sign up for: 12 questions, where each answer usually comes from, and a log to record them. If you want the exact wording for the phone call, use the insurance verification call script, which has the same questions in 21 steps.

The checklist: 12 questions that matter

Before you start: the member ID, date of birth and name exactly as they appear on the card; your NPI and Tax ID; the codes you plan to bill (97802 for the first visit, 97803 for follow-ups, 97804 for groups); and the referral diagnosis (ICD-10), if the patient has one.

Coverage

• 1. Is the plan active on the date of service? Also note the plan type (HMO, PPO, EPO, POS) and whether it's fully insured or self-funded. Self-funded employer plans often follow different rules (ERISA plans).
• 2. Am I in network for this plan, not just this payer? One payer can run several networks. For an out-of-state Blue plan, check through your local Blue plan (BlueCard).
• 3. Are 97802 and 97803 covered for this diagnosis? Give the actual ICD-10 code. Ask whether they'd accept Z71.3 alone (Z71.3) or need a condition code, and whether BMI codes (Z68) must be paired with an obesity code.

Benefit routing

• 4. Preventive or medical benefit? Under the ACA, most non-grandfathered plans cover certain preventive services, including diet counseling for adults at higher risk of chronic disease, with no cost share in network (HealthCare.gov; see the USPSTF recommendations on healthy diet counseling and weight loss interventions). Which diagnosis codes send a visit to the preventive benefit depends on the plan's policy. Ask for them. More in preventive vs. medical benefits.

Limits

• 5. What's the visit or hour limit, and is it per calendar year or plan year? Ask whether it's shared with other providers.
• 6. How many visits or hours are already used this year? Other dietitians' visits count against the same limit. For Medicare MNT: 3 hours in the first calendar year, 2 in later years, and unused hours don't carry over (CMS Ch. 4 §300.2). Limit denials are covered in CO-119.

Requirements

• 7. Is a referral required? From whom, and does it need to be on the claim? Medicare MNT always needs a physician referral with the physician's NPI on the claim (Medicare MNT billing).
• 8. Is prior authorization required? If yes, ask for how many visits and for what dates (prior authorization).
• 9. Telehealth: covered? Which POS (10 or 02) and which modifier? Paid the same as in person? See telehealth billing for dietitians.

Money

• 10. What does the patient owe? Copay, coinsurance, and whether the deductible applies to this benefit.
• 11. How much of the deductible and out-of-pocket maximum is met? More in collecting copays.

Paper trail

• 12. Rep's name, date and time, and a call reference number. Also ask for the claims address or payer ID and the timely filing limit (timely filing by payer).

Where an electronic check answers these, and where it can't

An electronic eligibility check (the X12 270/271 transaction, run through your clearinghouse) takes seconds, so run it first. Then call only for what it didn't answer. Claim.MD's own documentation notes that most payers respond to a benefit type, not to a procedure code (Claim.MD: Eligibility), so a code-level answer for 97802 is uncommon.

"Usually," "sometimes" and "rarely" are general patterns from working claims, not payer guarantees. Responses vary by payer and plan. The details are in electronic eligibility checks vs. phone verification. Payer-by-payer notes (Aetna, UnitedHealthcare, Cigna, Blue Cross, Medicare and others) are in the nutrition coverage by payer hub.

Verification log (copy or print)

NUTRITION BENEFITS VERIFICATION — [practice name]
Patient: ____________________  DOB: __________  Member ID: ______________
Payer / plan: ________________  Plan type: HMO / PPO / EPO / POS / Medicare / MA / Medicaid
Fully insured / self-funded: ____   Effective dates: __________ to __________
Checked: [ ] electronic (270/271) on ____   [ ] call on ____   [ ] portal on ____

1  Active on DOS:           Y / N         2  In network (this plan):  Y / N
3  97802/97803 covered for ICD-10 ________:  Y / N   Z71.3 alone OK: Y / N
4  Benefit: preventive / medical   Preventive dx codes: ___________________
5  Limit: ____ visits / hours per calendar / plan year   Shared: Y / N
6  Used this year: ____          Remaining: ____
7  Referral required: Y / N   From: __________   On claim: Y / N
8  Prior auth: Y / N   Auth #: ________   Visits: ____   Dates: ________
9  Telehealth covered: Y / N   POS: 10 / 02   Modifier: 95 / GT / none   Parity: Y / N
10 Copay: $____   Coinsurance: ___%   Deductible applies: Y / N
11 Deductible: $____ met $____    OOP max: $____ met $____
12 Rep: __________  Date/time: __________  Reference #: ______________
   Payer ID / claims address: __________   Timely filing: ____ days

Notes / next re-verify date: _____________________________________________
Verified by: __________

Keep the log with the patient's record. Re-verify at the start of each plan year, when the patient changes plans, and before a visit that could go over a limit.

Doing this for every patient

For a solo practice, the checklist takes an electronic check and usually one call per new patient. It's worth doing, because a missed limit or preventive-routing rule shows up weeks later as a denial you can't bill the patient for.