Insurance coverage of services provided by a naturopathic physician (naturopath) is determined by multiple factors.  An insurance company may or may not credential and contract naturopathic physicians.  If a an insurance company does credential and have a contract with a naturopathic physician (naturopath), that does not mean that every service the naturopathic physician (naturopath) provides will be covered and reimbursed by the insurance company.

In the USA, there are currently 5 states that have laws regarding the non-discrimination of healthcare providers by insurance companies.

• Vermont

  • Vermont Statutes, Title 8, Chapter 107, Section 4088d Coverage for covered services provided by naturopathic physicians

• Alaska

  • Alaska Statutes, Title 21, Chapter 21.36, Section 21.36.090 Unfair discrimination

• Connecticut

  • General Statutes of Connecticut, Title 38a, Chapter 700c, Section 38a-479 Definitions – Access to fee schedules – Fee information to be confidential
  • General Statutes of Connecticut, Title 38a, Chapter 700c, Section 38a-551 Definitions
  • General Statutes of Connecticut, Title 38a, Chapter 704, Section 38a-816 Unfair practices defined

• Montana

  • Montana Code Annotated, 33-22-111 Policies and certificates to provide freedom of choice of practitioners — professional practice not enlarged
  • Montana Code Annotated, 33-30-1017 Coverage required for services provided by naturopathic physicians

• Washington

  • Revised Code of Washington, RCW 48.43.043 Health plan requirements––Annual reports––Exemptions

 

 

These laws protect a patient’s right to access the medical system by seeing whichever healthcare provider he or she chooses to see, who is acting within that provider’s scope of practice.  These state laws were enacted prior to the federal law of the Patient Protection and Affordable Care Act (PPACA) Section 2706.  These laws establish inclusion of naturopathic physicians, who are either credentialed as primary care providers (PCPs) or specialty care providers.  Just like allopathic physicians (allopaths) and osteopathic physicians (osteopaths), naturopathic physicians (naturopaths) can be credentialed as either, depending on whether the focus of their practice is primary care or specialty care.

 

 

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Below are answers to frequently asked questions about insurance coverage of naturopathic medical services in the USA.

 

How are naturopathic physicians (naturopaths) credentialed?¹

Naturopathic physicians (naturopaths) are specialized in naturopathic medicine (naturopathy) and are trained in outpatient family medicine and primary care medicine, with an emphasis on prevention and wellness through the use of naturopathic treatment modalities.  Thus, just like allopathic physicians (allopaths) and osteopathic physicians (osteopaths), naturopathic physicians (naturopaths) can be credentialed as either specialists or primary care providers, depending on whether the focus of their practice is specialty care or primary care.

In some states, state laws mandate that naturopathic physicians (naturopaths) are credentialed as specialists, whereas, in other states, state laws mandate that naturopathic physicians (naturopaths) are credentialed as primary care providers (PCPs).

 

Do naturopathic physicians (naturopaths) use CPT codes?²

Yes, naturopathic physicians (naturopaths) use the same Current Procedural Terminology (CPT) codes as allopathic physicians (allopaths) and osteopathic physicians (osteopaths).

 

Do naturopathic physicians (naturopaths) use ICD codes?³

Yes, naturopathic physicians (naturopaths) use the same World Health Organization (WHO) International Classification of Diseases (ICD) codes as allopathic physicians (allopaths) and osteopathic physicians (osteopaths).  The current ICD codes being used are from the International Statistical Classification of Diseases and Health Related Problems 10^th Revision and are known as ICD-10 codes.

 

What ICD-10 codes do naturopathic physicians (naturopaths) use for osseous and soft tissue manipulative therapy?⁴

For osseous and soft tissue manipulative medicine and therapy, naturopathic physicians (naturopaths) use the same ICD-10 codes that osteopathic physicians (osteopaths) use for osteopathic manipulative treatment (OMT).  Insurance companies will reject a claim if a chiropractic ICD-10 code is used.

 

Do naturopathic physicians (naturopaths) provide “Essential Health Benefits” services specified in the PPACA?⁵

Yes, naturopathic physicians provide “Essential Health Benefits” services specified in Section 1302(b)(1) of the Patient Protection and Affordable Care Act (PPACA), including services in the categories of “Ambulatory patient services,” “Maternity and newborn care,” “Mental health and substance use disorder services, including behavioral health treatment,” “Prescription drugs,” “Rehabilitative and habilitative services and devices,” “Laboratory services,” “Preventative and wellness services and chronic disease management,” and “Pediatric services, including oral and vision care.”  Like allopathic and osteopathic physicians, naturopathic physicians perform ambulatory care services, such as taking routine physical examinations and thorough health histories; perform cardiovascular screenings and Pap smears; and order laboratory tests, imaging procedures, colonoscopies, mammograms, and other diagnostic tests.

 

REFERENCES

1. How are naturopathic physicians (naturopaths) credentialed?

   • Vermont General Assembly.  The Vermont Statutes Online – Title 08 Chapter 107 Subchapter 001 Section 4088d.  Accessed on 2016 Apr 12.

2. Do naturopathic physicians (naturopaths) use CPT codes?

   • American Medical Association.  CPT – Current Procedural Terminology.  Accessed on 2016 Apr 12.

3. Do naturopathic physicians (naturopaths) use ICD codes?

   • World Health Organization.  Classifications:  International Classifications of Diseases (ICD).  Accessed on 2016 Apr 12.
   • World Health Organization.  ICD-10 Version:2016 – International Statistical Classification of Diseases and Related Health Problems 10^th Revision.  Accessed on 2016 Apr 12.

4. What ICD-10 codes do naturopathic physicians (naturopaths) use for osseous and soft tissue manipulative therapy?

   • World Health Organization.  Classifications:  International Classifications of Diseases (ICD).  Accessed on 2016 Apr 12.
   • World Health Organization.  ICD-10 Version:2016 – International Statistical Classification of Diseases and Related Health Problems 10^th Revision.  Accessed on 2016 Apr 12.

5. Do naturopathic physicians (naturopaths) provide “Essential Health Benefits” services specified in the PPACA?

   • Patient Protection and Affordable Care Act.  Section 1302(b) Essential Health Benefits.  Accessed on 2016 Apr 12.
   • Cigna.  Informed on Reform:  Essential Health Benefits Fact Sheet.  Accessed on 2016 Apr 12.
   • Legislature of the Virgin Islands – Office of the Code Revisor.  V.I.C. Title 27 Chapter 4 Section 192.  Accessed on 2016 Oct 05.