CNS vs. Dietitians: Why We Shouldn't Be Competing, But Collaborating
In the world of nutrition, there's often an unspoken divide between Certified Nutrition Specialists (CNSs) and Registered Dietitians (RDs or RDNs). Both are highly trained professionals with deep commitments to evidence-based care and client outcomes, yet they’re sometimes positioned as competitors. In reality, there's more overlap than conflict, especially when it comes to licensure, credentialing, and billing. Here's a closer look at each path and why it's time to focus on collaboration instead of comparison.
Education & Credentialing Requirements
Certified Nutrition Specialist (CNS)
Education: Requires a Master's or Doctoral degree in nutrition or a related field.
Supervised Practice: Minimum of 1,000 hours of supervised practice experience.
Board Exam: Must pass the Board for Certification of Nutrition Specialists℠ (BCNS℠) exam
Scope: Often trained in clinical, functional, and integrative nutrition approaches.
CNS Candidates: Individuals who hold a Master’s degree in nutrition (or equivalent) and are completing their 1,000 supervised hours fall into this category. CNS candidates differ significantly from health coaches or unlicensed "nutritionists" without a graduate-level degree. They follow a structured clinical pathway and are working toward national board certification.
Registered Dietitian (RD/RDN)
Education: As of January 1, 2024, a Master's degree is now required to sit for the RD exam (previously only a Bachelor's was required).
Supervised Practice: At least 1,000 hours through an ACEND-accredited internship or coordinated program.
Board Exam: Must pass the Commission on Dietetic Registration (CDR) exam.
Scope: Typically trained in medical nutrition therapy, hospital-based care, and public health nutrition.
Licensure & State Regulation
Licensing varies by state, but many require both CNSs and RDs to obtain a license to practice nutrition. Some states offer licensure or certification to CNS professionals (e.g., Washington State’s Certified Nutritionist license, Maryland and Pennsylvania Licensed Dietitian Nutritionist (LDN)), while others only recognize dietitians. A few states are still restrictive toward CNS practice, but that landscape is slowly changing.
States That Recognize CNSs:
Washington: Certified Nutritionist (CN) license
Maryland, Pennsylvannia, New Mexico, Connecticut, Florida: Allow CNSs to apply for licensure as LDNs or similar titles
It's important to note that both RDs and CNSs often operate under the same CPT billing codes, especially when credentialed with insurance. Insurance panels typically recognize both if they are licensed in the state and credentialed correctly.
Insurance Billing & CPT Codes
A major misconception is that only dietitians can bill insurance. In reality:
CNSs can bill insurance in states where they are licensed and credentialed.
Both CNSs and RDs use the same CPT codes, such as:
97802 (Medical Nutrition Therapy, initial)
97803 (MNT, follow-up)
99401-99404 (Preventive counseling codes)
Credentialing and licensure—not title—are what determine eligibility to bill insurance. The key is proper setup: NPI registration, business licensing, liability insurance, and insurance panel credentialing.
Why They Shouldn’t Be Pitted Against Each Other
The truth is, both CNSs and RDs:
Complete rigorous academic and supervised training
Are held to high ethical standards
Deliver personalized, evidence-based nutrition counseling
Support clients across chronic conditions, lifestyle management, and preventative care
The real gap isn’t between the credentials—it’s in public and institutional awareness. Instead of viewing each other as competition, nutrition professionals can unite to advocate for better insurance access, licensure recognition, and patient-centered care models.
Final Thoughts
Whether you're a CNS, CNS candidate, or RD, your work is vital. Both credentials bring unique strengths to the table, and both deserve recognition, licensure opportunities, and fair access to insurance reimbursement. Let’s shift from division to collaboration and continue advocating for broader access to whole-person nutrition care.
Want help navigating licensure or insurance credentialing as a CNS or RD?
Book a Discovery Call with Holistika Consulting
References
American Nutrition Association (ANA): https://theana.org
Academy of Nutrition and Dietetics (AND): https://www.eatrightpro.org
