The Medical Nutrition Therapy benefits for your Keystone 65 Basic HMO, Keystone 65 Select HMO, Keystone 65 Preferred HMO, and Personal Choice 65SM PPO Medicare Advantage patients changed on January 1, 2015. Please review the information below regarding eligibility and coverage limitations to avoid claim processing delays and/or denials.
Who is eligible?
Keystone 65 Basic HMO, Keystone 65 Select HMO, Keystone 65 Preferred HMO, and Personal Choice 65 PPO members with a Medicare medical benefit Part B who meet at least one of the following conditions are eligible to receive coverage for Medical Nutrition Therapy Services:
- diabetes
- renal (kidney) disease (but not on dialysis)
- have had a kidney transplant in the last 36 months (when therapy is ordered by a doctor)
Medical Nutrition Therapy services require a referral (HMO members only) and must be performed by a registered dietician or nutrition professional who meets certain requirements. Services may include nutritional assessment, one-on-one counseling, and therapy services.
Limitations of coverage
Eligible Medicare Advantage HMO and PPO members are limited to the following benefits for Medical Nutrition Therapy per calendar year:
- three hours of one-on-one counseling during the first year of Medical Nutrition Therapy under their Medicare Advantage coverage;
- two hours of one-on-one counseling each year after the first year.
There is no copayment, coinsurance, or deductible for eligible patients receiving Medical Nutrition Therapy within the limitations listed.
Providers may prescribe additional hours of treatment if the patient?s condition changes; however, a claim may be denied if a provider recommends services for patients who do not meet the eligibility requirements, recommends services that Medicare does not cover, or requests services more often than Medicare covers.
Be sure to renew services yearly for patients if treatment continues into the next calendar year.
Claims processing
To avoid delays in processing claims and/or denials, it is imperative that your office staff do the following at every visit:
- Verify eligibility and benefits using the NaviNet® web portal prior to prescribing or rendering Medical Nutrition Therapy services.
- Obtain a copy of the member?s current ID card to ensure that you submit the most up-to-date information to Independence.
If you have any questions about coverage for Medical Nutrition Therapy services for Medicare Advantage HMO and PPO members, please contact your Network Coordinator.
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