Billing for nutritional counseling
Fully funded and Medicaid members are eligible for this service. No authorization is required for payment, however PCP referral is encouraged.
- Bill on a UB04 with revenue code 942, OR for registered dietitians in a physician office setting, you may bill on a HCFA 1500 (report with AE modifier).
- CPT codes accepted:
- 97802: Medical Nutrition Therapy: Initial one-on-one* with the patient, 15 minutes
- 97803: Medical Nutrition Therapy: Follow-up one-on-one* with the patient, 15 minutes
- 97804: Medical Nutrition Therapy: Group session, 30 minutes or more
- Units billed should total the time spent. Example: For 30-minute visits, bill 2 units.
Nutritional counseling benefit, fully funded plans
Nutritional counseling is a covered benefit for plan members when services are rendered by a registered dietitian.
- Number of covered visits may vary based on plan benefits.
- Services should be reported with a valid CPT code by any one of:
- A participating hospital
- A registered dietitian in the provider office setting (report the AE modifier to indicate registered dietitian performed this service)
- A health department, directly
Nutritional counseling benefit, self-funded plans
Nutritional counseling may be reimbursed, depending on the employer plan benefits.
Nutritional counseling benefit, Priority Health Medicare plans
- Covered for individuals who are diabetic or have been diagnosed with renal failure
- Not covered for maintenance dialysis
- Not covered for other conditions
More information
Go to the CMS nutrition therapy Web page
Contact the Provider Helpline for specific member benefits.
