Texas insurance law on MNT and nutrition counseling
The short answerTexas requires covered health benefit plans that cover diabetes treatment to cover diabetes self-management training, which includes nutrition counseling. When the training is delivered by components, the licensed dietitian who provides the nutrition counseling component must be paid. Separately, an accident and health policy may not exclude or deny coverage for dietitian services within the license, when they relate to a covered illness and follow a physician's recommendation.
By Javier Alvarez · Updated · 2 min read
1 row: State insurance law · Texas. Public policy, not the member's benefits.
Texas insurance law
Fully insured plans (Tex. Ins. Code ch. 1358 and s. 1451.302) · Texas
| 97802 | Not published |
|---|---|
| 97803 | Not published |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Applies to individual, group, blanket and franchise policies and HMO evidence of coverage that provide coverage for diabetes treatment. Small employer health benefit plans written under Chapter 1501 are excepted from subchapter B. [1] |
| Diagnoses | A qualified enrollee has insulin dependent or noninsulin dependent diabetes, elevated blood glucose levels induced by pregnancy, or another medical condition associated with elevated blood glucose levels. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Training covers the period after initial diagnosis, additional training after a significant change in symptoms or condition, and periodic or episodic continuing education training. A plan may apply a deductible, copayment or coinsurance no higher than for analogous chronic conditions. [1] |
| Referral and prior auth | When training is provided on the written order of a physician or other health care practitioner, it must include an ADA-recognized program, a multidisciplinary team, a certified diabetes educator, or defined components such as nutrition counseling. [1] |
| Who can bill | Where the training is delivered by components, nutrition counseling is provided by a licensed dietitian, for which the dietitian shall be paid. A nurse or physician assistant may be paid for nutrition counseling only if a licensed dietitian is unavailable. Section 1451.302 also bars a policy from denying payment for dietitian services within the license scope, tied to an illness the policy covers and a physician recommendation. [1][2] |
What the Texas law says
- Where it applies. Applies to individual, group, blanket and franchise policies and HMO evidence of coverage that provide coverage for diabetes treatment. Small employer health benefit plans written under Chapter 1501 are excepted from subchapter B.
- Diagnoses. A qualified enrollee has insulin dependent or noninsulin dependent diabetes, elevated blood glucose levels induced by pregnancy, or another medical condition associated with elevated blood glucose levels.
- Visit limits. Training covers the period after initial diagnosis, additional training after a significant change in symptoms or condition, and periodic or episodic continuing education training. A plan may apply a deductible, copayment or coinsurance no higher than for analogous chronic conditions.
- Referral and prior auth. When training is provided on the written order of a physician or other health care practitioner, it must include an ADA-recognized program, a multidisciplinary team, a certified diabetes educator, or defined components such as nutrition counseling.
- Who can bill. Where the training is delivered by components, nutrition counseling is provided by a licensed dietitian, for which the dietitian shall be paid. A nurse or physician assistant may be paid for nutrition counseling only if a licensed dietitian is unavailable. Section 1451.302 also bars a policy from denying payment for dietitian services within the license scope, tied to an illness the policy covers and a physician recommendation.
What it means for a claim in Texas
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 Texas, 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 Texas: Aetna in Texas, Texas Medicaid and BCBS of IL, TX, OK and NM (HCSC). The state laws side by side compare Texas with other states.