Colorado insurance law on MNT and nutrition counseling
The short answerColorado requires health benefit plans that cover hospital, surgical or medical expenses to cover diabetes outpatient self-management training and education, including medical nutrition therapy, if a licensed prescriber orders it. Managed care plans may require a participating provider.
By Javier Alvarez · Updated · 1 min read
1 row: State insurance law · Colorado. Public policy, not the member's benefits.
Colorado insurance law
Fully insured plans (C.R.S. 10-16-104(13)) · Colorado
| 97802 | Not published |
|---|---|
| 97803 | Not published |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Any health benefit plan that provides hospital, surgical, or medical expense insurance, except supplemental policies covering a specified disease or other limited benefit. [1] |
| Diagnoses | Not published: call the payer. |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Medical nutrition therapy and training are covered if prescribed by a health-care provider licensed to prescribe such items under Colorado law. [1] |
| Who can bill | Training and education is provided by a certified, registered, or licensed health-care professional with expertise in diabetes. If coverage is through a managed care plan, the qualified provider must be a participating provider in the plan. [1] |
| Payment | Benefits are subject to the same annual deductibles or copayments as other covered benefits in the policy. Private third-party payors may not reduce or eliminate coverage because of this subsection. [1] |
What the Colorado law says
- Where it applies. Any health benefit plan that provides hospital, surgical, or medical expense insurance, except supplemental policies covering a specified disease or other limited benefit.
- Referral and prior auth. Medical nutrition therapy and training are covered if prescribed by a health-care provider licensed to prescribe such items under Colorado law.
- Who can bill. Training and education is provided by a certified, registered, or licensed health-care professional with expertise in diabetes. If coverage is through a managed care plan, the qualified provider must be a participating provider in the plan.
- Payment. Benefits are subject to the same annual deductibles or copayments as other covered benefits in the policy. Private third-party payors may not reduce or eliminate coverage because of this subsection.
What it means for a claim in Colorado
The law sets a floor for the plans it reaches; the plan's own policy and the member's contract still decide the codes, units and referral. On the benefits call, ask whether the plan is fully insured in Colorado, and if a covered service is denied, name the statute by section in the appeal. The sources below link to the statute itself.
Payers with their own row for Colorado: Anthem Blue Cross and Blue Shield, Kaiser Permanente and Colorado Medicaid (Health First Colorado). The state laws side by side compare Colorado with other states.