Nutritional Counseling for Eating Disorders Form

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Nutritional Counseling for Eating Disorders - Medical Policy
Updated Revision Effective: 7/1/2025
Policy Number:

UM949POL

Approval Date: 5/13/2025

Line(s) of Business:

Commercial
Medicare Advantage
Medicaid (BeHealthy)

Description

Nutritional counseling is individualized advice and guidance given to members at nutritional risk due to nutritional history, current dietary intake, medication use, or chronic illness.

Nutritional counseling of individuals with eating disorders as part of a multidisciplinary treatment program is supported by the American Psychological Association and the American Academy of Pediatrics.

Registered Dieticians (RD) are qualified to provide Medical Nutrition Therapy (MNT) and counsel individuals on behavioral and lifestyle changes that may impact long-term eating habits and health. MNT is an evidence-based application which can include a comprehensive nutrition assessment, determination of a nutrition diagnosis, intervention, and monitoring and evaluation of progress toward goals.

 Line of Business

Commercial:
Refer to criteria under the Policy section in this medical policy.

Medicaid – BeHealthy:
Refer to criteria under the Policy section in this medical policy. There are no MassHealth guidelines for nutritional counseling for eating disorders.

Medicare: This policy does not apply. Please refer to the member’s documents.

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Policy

We cover medically necessary nutritional visits for the following eating disorders:

• Anorexia Nervosa • Bulimia Nervosa • Binge Eating Disorder • Avoidant Restrictive Food Intake Disorder • Other Eating Disorders • Eating Disorder Unspecified • Pica in adults • Rumination disorder in adults

Nutritional visits for inappropriate diet and eating habits beyond the benefit listed in the coverage documents are considered to be a benefit exclusion.

Policy Guidelines and Definitions

Documentation of nutritional counseling and treatment for eating disorders must include a clinical summary with a dietary assessment.

The following information must be included if applicable:

• Frequency of nutrition counseling follow up appointments • Percent of meal plan compliance • Weight chart with a goal weight range • Frequency of: o Binges o Purges o Laxative misuse o Number of meals skipped o Number of minutes exercised • Transition to/from a higher level of care • Percentage of day spent in food-related thoughts • Physical Health • Nutrition-related abnormalities • Flexibility in food selection and inclusion of fear foods.

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Definitions:

Anorexia Nervosa Anorexia nervosa is characterized by dietary restriction that causes an abnormally low body weight and can be life threatening and require hospitalization in severe cases.

Symptoms Include:
• Restriction of energy intake that leads to a low body weight, given the patient’s age, sex, developmental trajectory, and physical health
• Intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite being underweight

Bulimia Nervosa Bulimia nervosa is characterized by a cycle of binging and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating. Bulimia nervosa can be harmful to multiple body systems.

Symptoms Include: • Episodes of binge eating, defined as consuming an amount of food in a discrete period of time that is definitely larger than what most people would eat in a similar amount of time under similar circumstances.
• A sense of lack of control overeating during the episode
• Recurrent inappropriate compensatory behavior to prevent weight gain
• Self-evaluation is unduly influenced by body shape and weight

Binge Eating Disorder
Binge Eating Disorder (BED) is a type of eating disorder that is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

Symptoms Include: • Episodes of binge eating, defined as consuming an amount of food in a discrete period of time that is definitely larger than what most people would eat in a similar amount of time under similar circumstances.
• A sense of lack of control overeating during the episode
• Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s low body weight
• No regular use of inappropriate compensatory behaviors (e.g., purging, fasting, or excessive exercise) as are seen in bulimia nervosa

Other Specified Feeding or Eating Disorder Formerly described at Eating Disorders Not Otherwise Specified (EDNOS) in the DSM-IV, Other Specified Feeding or Eating Disorder (OSFED) is a feeding or eating disorder that causes significant distress or impairment, and behaviors do not meet full criteria for any of the other feeding and eating disorders, but still cause clinically significant problems. The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. Significant clinical impact on daily health and functioning must be clearly documented for purposes of medical necessity.

Avoidant/Restrictive Food Intake Disorder • Failure to consume adequate amounts of food, with serious nutritional consequences, but without the psychological features of Anorexia Nervosa

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• Reasons for the avoidance of food include fear of vomiting or dislike of the textures of the food.

Coding Guidance

The following diagnoses are considered medically necessary when the applicable criteria in this policy are met:

Code
Description
F50.00 Anorexia Nervosa, unspecified F50.01 Anorexia Nervosa, restricting type F50.02 Anorexia Nervosa, binge eating/purging type F50.2 Bulimia Nervosa F50.81 Binge Eating Disorder F50.82 Avoidant/restrictive food intake disorder F50.83 Pica in adults F50.84 Rumination disorder in adults F50.89 Other specified eating disorder F50.9 Eating Disorder, unspecified

CPT® Copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Note: CPT/HCPCS codes are included for informational purposes and may not be all inclusive. Inclusion or exclusion of a CPT/HCPCS code(s) does not signify or imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member’s specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee of payment. Other policies and coverage determination guidelines may apply.

References

1. American Dietetic Association. Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS). J Am Diet Assoc. 2001; 101(7):810-819

2. Recovery from an Eating Disorder: Conceptualization, Validation, and Examination of Psychosocial Functioning and Psychiatric Comorbidity. 2010. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829357 June 2015.

3. International Association of Eating Disorders Professional Foundation.

   http://www.iaedp.com

4. Feeding and Eating Disorders. American Psychiatric Publishing. 2013. Retrieved from: http://www.dsm5.org/Documents/Eating%20Disorders%20Fact%20Sheet.pdf June 2015.

5. Eating disorders: Overview of prevention and treatment, UpToDate. Updated 2/2023. Accessed 3/2023

6. Eating disorders: Overview of epidemiology, clinical features, and diagnosis, UpToDate. Updated 2/2023. Reviewed 3/2023

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Policy Implementation

Approved by the Medical and Pharmacy Policy Committee

Kate McIntosh MD MBA

Chief Medical Officer

Saad Usmani MD MBA

Medical Director

Date Update 3/2023 New policy 2/2024 Line of Business section added 4/2024 Reviewed with no changes 3/2025 Added ICD-10 codes F50.83 and F50.84 to list of medically necessary diagnosis codes.
Removed reference to payment policy.

Medical Criteria Disclaimer

Property of Health New England. All rights reserved. The treating physician or primary care provider must submit to Health New England the clinical evidence that the patient meets the criteria for the treatment, testing or surgical procedure. Without this documentation and information, Health New England will not be able to properly review the request for prior authorization. The clinical review criteria reflect how Health New England determines whether certain services or supplies are medically necessary. Health New England established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Health New England expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by Health New England, as some programs exclude coverage for services or supplies that Health New England considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication. Health New England has adopted the herein policy in providing management, administrative and other services to its Health Plan.