Updated October 2017 with the most current ICD-10-CM codes pertaining to medical nutrition therapy. The reverse side of the forms lists additional ICD-10 codes for easy reference. Your clients can submit this form to their insurance company to seek reimbursement for your services, if their plan allows.
We will customize this form for you to ensure that your information fits nicely in the header. You can include your business name, your name, title, credentials, address, email, phone numbers, NPI and licensure numbers.
This is a downloadble PDF file. You will receive your customized form within 48-72 hours after receipt of your personalization information, which you can enter in the Custom Text Field on this order.
Medical Nutriton Therapy Super Bill ICD-10 Codes - Customized Form
This is a fillable PDF file file which allows you to personalize the form with your information. If you would like the form personalized for you, please order the custom version of this form in separate listing.
This is a downloadable, digital file and therefore there are no returns or refunds. This product is intended for the sole use of the purchaser, and may not be resold or shared online.