Fee Schedules for Insurance Plans

Are fee schedules for insurance plans published?

-Medicare and Medicaid are public programs so the physician fee schedules for these are published online. The fees are assigned by geographic location, code used and number of units allowed. You can locate fees for Medicare MNT services for diabetes and/or CKD (EGFR 13-50 and up to 3 years post transplant. Remember the fees are listed by 1 unit increments.  For 97802 and 97803= 15 minute Increments; 97804 group is 30 minutes.

Fees listed are what a physician would receive doing the same service. To calculate the RDN rate multiply by 85%. Yearly, the Academy posts the precalculated fee schedule in the Reimbursement Community of Interest. Take advantage of the free benefit for Academy members.

-Commercial insurers usually do not publish reimbursement rates. However, they do have a standard fee schedule that you can request prior to applying to be a provider. 

These rates are proprietary and may be renegotiated with each provider prior to signing a contract. It is always easiest to negotiate prior to signing the contract. Once contracted you may renegotiate an increase in rates. It is more difficult to do this and you will need to be persistent with value-added statements to support and outcome data to increase in fee. Current fees for public programs may help your request to receive a re-evaluation of rates.

-Discussing fees on electronic mail lists for the Academy of Nutrition and Dietetics or other Listservs is considered price fixing by the federal government and you may be penalized. EMLs will remind you that your online fee discussion will be deleted.

-To determine your fees, use the calculator available in our membership area. 

-For direction and goal setting for your nutrition business—private practice, clinic or office settings, schedule your free coaching session here.