Nutrition counseling billing

The benefit limit is 6 visits per contract year.

No authorization is required for participating providers. However, PCP referral is encouraged.

Services may be reported with a valid CPT code by:

  • Participating hospitals/facilities: Report with revenue code 0942 on the UB04.
  • Registered dietitians in the provider office setting: Report with the AE modifier.
  • Health departments

Units billed should total the time spent. Example: For 30-minute visits, bill 2 units.

Medical nutrition therapy codes accepted:

Covered for fully funded, self-funded, MyPrioritySM, Medicare and Priority Health Choice (Healthy Michigan Plan and Medicaid) members.

  • 97802: Initial one-on-one* with the patient, 15 minutes
  • 97803: Follow-up one-on-one* with the patient, 15 minutes
  • 97804: Group session, 30 minutes or more
  • G0270: Reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes
  • G0271: Reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes

Nutrition counseling benefit, Priority Health Medicare plans

  • Covered for individuals who
    • Are diabetic (Type 1 and Type 2)
    • Have been diagnosed with renal failure
    • Have received a kidney transplant within the last 3 years
  • Not covered for individuals
    • Who are pre-diabetic or have other medical conditions
    • On maintenance dialysis  

Last modified: 4/28/2014
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