Highmark Commercial Medical Policy - West Virginia |
Medical Policy: | V-44-015 |
Topic: | Medical Nutrition Management Services (MNT) |
Section: | Visits |
Effective Date: | October 1, 2016 |
Issue Date: | February 27, 2017 |
Last Reviewed: | February 2017 |
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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Policy Position Coverage is subject to the specific terms of the member’s benefit plan. |
Medical nutrition therapy (MNT) is covered for certain conditions listed below. This list includes those diagnoses/conditions that most commonly benefit from MNT in improving desired health outcomes. (This is not intended to be an all-inclusive list.)
Medical nutrition therapy may also be covered for the management of obesity per the member's group or individual benefit program.
Preventive medicine counseling, for patients with risk factors for diet related chronic diseases, is covered for the following:
When reported separately, charges for medical nutrition therapy should be combined with and processed under the appropriate medical visit procedure codes. If MNT is the only service performed, it will be reimbursed in accordance with the member's medical care benefits. Modifier 25 may be reported with medical care (e.g. visits, consults) to identify it as significant and separately identifiable from the other service(s) provided on the same day. When modifier 25 is reported, the patient’s records must clearly document that separately identifiable medical care was rendered.
When the 25 modifier is reported, the patient's records must clearly document that separately identifiable medical care has been rendered.
See Medical Policy Bulletin Z-27 for information on Eligible Providers and Supervision Guidelines. See Medical Policy Bulletin G-24 for information on the Treatment of Obesity. See Medical Policy Bulletin E-15 for information on Diabetic Services and Supplies. See Medical Policy Bulletin V-37 for information on Autism Spectrum Disorders. |
Place of Service: Inpatient/Outpatient |
Medical Nutrition Therapy (MNT) is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.
The policy position applies to all commercial lines of business |
Denial Statements |
Services that do not meet the criteria of this policy will not be considered medically necessary. A network provider cannot bill the member for the denied service unless: (a) the provider has given advance written notice, informing the member that the service may be deemed not medically necessary; (b) the member is provided with an estimate of the cost; and (c) the member agrees in writing to assume financial responsibility in advance of receiving the service. The signed agreement must be maintained in the provider’s records.
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