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.
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.
Below are answers to frequently asked questions about insurance coverage of naturopathic medical services in the USA.
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).
Yes, naturopathic physicians (naturopaths) use the same Current Procedural Terminology (CPT) codes as allopathic physicians (allopaths) and osteopathic physicians (osteopaths).
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.
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.
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.