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.
• Use CPT code:
  • 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 Help Line for specific member benefits.