Can MNT Be Covered By Insurance?

Coverage for MNT in the United States varies considerably by payer type. Federally, for Medicare Part B, MNT is covered when a beneficiary has diabetes, non-dialysis chronic kidney disease (stage 3-5), or has had a kidney transplant within the past 36 months. A Medicare-enrolled RDN can schedule and bill for services after obtaining a physician signed (MD or DO) referral, at this time mid-level providers currently do not qualify to sign MNT referrals for Medicare benefit. Medicare provides for up to three hours of MNT in the first year of referral and up to two hours in each subsequent year (with allowance for additional hours if deemed medically necessary). ³ As of January 2025, RDNs can also bill for Direct Training Caregiver Services, which means they can provide education and training to unpaid caregivers who help with tasks like meal preparation and wound care. ²

Medicaid programs are financed by both the state and federal governments, but each state can determine its own coverage and
reimbursement for specific services. State Medicaid programs exhibit significant variability in their coverage and reimbursement rates for MNT services. A recent mapping project by the Academy of Nutrition and Dietetics 4 found that while 37 states recognize MNT billing codes, in only 26 states can RDNs enroll as Medicaid providers (one additional state for pediatric services only), and in only 23 states can RDNs bill independently (others can bill incident-to services). Coverage for MNT services also varies, with some limiting depending on the diagnosis to other states providing reimbursement for a broad range of preventive and medical nutrition therapy. 5

Commercial insurance plans also vary widely in their benefit structure, with some limiting coverage while others extending beyond Medicare-covered diabetes and CKD to also include pre-diabetes, obesity, malnutrition, cardiovascular disease (including hypertension and dyslipidemia), cancer, eating disorders, gastrointestinal conditions, and more.

Although some plans have expanded their coverage, it is not universal and understanding coverage requires knowing an individual’s insurance plan benefits, the RDN network status, diagnosis and referral requirements, the number of covered visits/hours/units, medical or preventive benefit coverage, and, if applicable, telehealth eligibility. Benefits can change annually, and reimbursement rates can also vary widely depending on the state and payer.

When the Affordable Care Act was implemented in 2010 it help provide premium subsidies and increased coverage of preventive and chronic disease services. This led to an increase in MNT coverage expectation and waived share-of-cost for individuals receiving MNT. However, in practice, coverage remains patchwork, with substantial variability in approved diagnoses, covered hours, cost-sharing requirements, and provider networks across plans.