Applies to:

All plans. See Medicare-specific coverage and billing information below.

Nutrition counseling, education and therapy visit coverage

• Self-funded plan members may have a copay, coinsurance, or deductible.
• Benefit limits apply, 6 visits per plan year

Medicare coverage

Nutrition education/counseling is a supplemental benefit separate from the Medicare-covered medical nutrition therapy preventive services benefit.

Nutrition education/counseling benefit:

• 6 half-hour visits per contract year
• Defined as general education classes or counseling provided in-home or in an outpatient setting by a registered dietitian
• Available to all Medicare members, regardless of whether they have an illness or not

Medical nutrition therapy benefit:

• 6 half-hour visits per contract year
• Limited to people with diabetes, renal (kidney) disease (but not on dialysis), or after a kidney transplant when ordered by the physician

Nutrition counseling, education and therapy visit authorizations

Not required. For Medicare, we encourage physician recommendation.

Nutrition counseling, education and therapy billing

Payable when billed by:

• Participating hospitals/facilities: Report with revenue code 0942 on the UB04.
• Participating home care agencies: Report with revenue code 0589 on the UB04.
• Registered dietitians billing under the supervising physician in the provider office setting: Report with the AE modifier.
• Health departments

Units billed

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

Codes accepted

For fully funded, self-funded and MyPriority® commercial members and for Priority Health Choice (Healthy Michigan Plan and Medicaid) members, these codes are accepted  for medical nutrition therapy, nutrition education, and nutrition counseling.

For Medicare, these codes are accepted for medical nutrition therapy only.

• 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

For Medicare, these codes are accepted for nutrition education/counseling:

• S9452: Nutrition classes, non-physician provider, per session
• S9470: Nutritional counseling, dietician visit