Letters of Medical Necessity

Edited

A Letter of Medical Necessity (LMN) is a document written by a healthcare provider, like a dietitian or physician, to justify the need for specific medical or nutrition-related services for a patient that was denied insurance coverage and would like to file an appeal with their insurance company. LMNs can often help patients who need it most get insurance coverage for Medical Nutrition Therapy (MNT) and other nutrition-related interventions.

The primary purpose of an LMN is to provide evidence that the prescribed treatment is essential for managing or improving a patient’s medical condition. It outlines the medical rationale for nutrition interventions and connects them directly to the patient’s diagnosis, which aligns with the insurer’s criteria for coverage.

Patients must be the ones to initiate an appeal process with their insurance company, but dietitians can provide an LMN to the patient if requested.

LMNs are typically used for:

  • Patients with chronic conditions such as diabetes, kidney disease, or heart disease, where MNT is integral to disease management.

  • Insurance plans that require additional documentation for specific services or if coverage limitations are present.

  • Requests for coverage of specialized nutrition interventions or products, such as enteral nutrition or supplements, when they are necessary for the patient's medical condition.

Key Components of an LMN

An effective LMN includes the following elements:

  1. Patient Information: Include patient name and date of birth

  2. Diagnosis: Clearly state the patient’s nutrition diagnosis and any relevant medical dx, providing relevant medical history to contextualize the condition. If a relevant medical Dx is listed, make sure there are medical records on file in the patient’s chart from the diagnosing provider that support that Dx being given.

  3. Clinical Justification: Describe why the nutrition services or interventions are medically necessary for the patient’s nutrition Dx. This section explains how the intervention(s) will help manage symptoms, improve quality of life, prevent complications, or support specific medical goals.

  4. Treatment Plan: Outline the recommended nutrition therapy or intervention(s), specifying frequency and duration of sessions, and any anticipated outcomes. This may include dietary education, behavioral counseling, or meal planning guidance.

  5. Provider Information: Include your name, credentials, signature, NPI number, and contact information of the provider writing the letter.

Tips for Writing an Effective LMN

  1. Be Specific and Concise: Use clear, straightforward language to explain the patient’s condition and the necessity of the treatment.

  2. Use Evidence-Based Language: Include references to clinical guidelines or research if possible to reinforce the medical need.

  3. Tailor Each Letter: Customize the LMN to reflect the unique needs and health status of each patient.

  4. Share Supportive Evidence: Include specific data to reference (e.g. nutrition related labs, anthropometrics, energy intake) to support care plan recommended.

Below is a template you can use for LMNs.

Step 1: Make a copy of the template in google docs

Step 2: Complete LMN with highlighted information

Step 3: Download google doc as PDF and send to patient that requested LMN

Letter of Medical Necessity Template