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.
- Unlimited visits per plan year
Medicare and commercial coverage
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 members with a diabetes or renal disease diagnosis
Medical nutrition therapy benefit:
- Three hours of total administration for the first year a beneficiary receives nutrition education / counseling, with either a diagnosis of renal disease or diabetes. Basic coverage in subsequent years for renal disease or diabetes is two hours. The dietitian/nutritionist may choose how many units are administered per day as long as all of the other requirements in are met. Additional hours are considered to be medically necessary and covered if the physician determines that there's a change in medical condition, diagnosis or treatment regimen that requires a change in nutrition education/counseling and orders additional hours during that episode of care.
- Limited to people with diabetes, renal (kidney) disease (but not on dialysis), or after a kidney transplant when ordered by the physician
For Medicare, nutrition education/counseling is a supplemental benefit separate from the covered medical nutrition therapy preventive services benefit.
Note: Medical nutrition therapy allowed units per benefit year is cumulative to additional conditions that are outlined in the policy for diabetes education programs.
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
Medical nutrition therapy should be provided by a state licensed or certified dietician.
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
One unit is payable per date of service when S codes are billed.