Navigate your PPO benefits
Medley Nutrition is currently a private-pay practice. We can provide documentation for clients who wish to seek out-of-network reimbursement. Coverage is determined by your individual health plan and is not guaranteed.
Your reimbursement path
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Call your insurer
- — Use the member services number on your insurance card.
- — Ask about out-of-network medical nutrition therapy (MNT).
- — Mention CPT codes 97802 (initial) and 97803 (follow-up).
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Confirm your costs
- — Out-of-network deductible and how much you have met.
- — Reimbursement percentage after the deductible.
- — Allowed amount for each CPT code—not your provider’s full fee.
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Check diagnosis requirements
- — Ask if a physician referral is required.
- — Ask which ICD-10 diagnosis codes your plan accepts.
- — Get applicable codes from your doctor if needed.
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Attend your visit
- — Pay at the time of your virtual session.
- — Request a superbill with CPT and ICD-10 codes.
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Submit your claim
- — Upload the superbill through your insurer’s portal or mail it in.
- — Keep copies. Reimbursement usually takes 2–4 weeks and is not guaranteed.
Ask your insurer
Out-of-network (OON) benefits
Do I have OON benefits for outpatient medical nutrition therapy (MNT)? If the answer is no, your plan may not reimburse—and it helps to know that up front. Mention CPT codes 97802 and 97803.
Your deductible
What is my OON deductible for nutrition services, and how much of it have I met this year? This is what you pay yourself before any reimbursement starts.
Your coinsurance
Once I have met it, what percent of each session do you reimburse? This is often somewhere around 50–80%, depending on your plan.
The allowed amount
What is the allowed amount for CPT code 97802 (initial) and 97803 (follow-up)? Your reimbursement is a percentage of this number, not your full fee—which is why it is the detail people most often overlook.
Educational information only. Coverage varies by plan and is not guaranteed. Medley Nutrition does not bill insurance directly.
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