Insurance coverage · Coverage
Illinois Medicaid nutrition counseling
By Javier Alvarez · Updated · 3 min read
| Fee schedule | HFS Practitioner Fee Schedule, eff. 07/01/2026 (updated 09/15/2026) |
|---|---|
| 97802, 97803, 97804, G0270, G0271 | Indicator 09: Qualified Medicare Beneficiary (QMB) coverage only |
| Dietitian provider type | None found |
| Covered alternative | DSMES (G0108/G0109) by ADCES-accredited or ADA-recognized organizations, Legacy PT 103 |
| DSMES amount | Up to 18 hours per 12 months: 3 individual, 15 group |
| Pending legislation | HB3434 (MNT by licensed RDs) and SB2374 (MNT pilot): not enacted |
| Last verified | September 28, 2026 |
The short answer
Illinois is one of the states where a registered dietitian can't bill Medicaid for medical nutrition therapy in fee-for-service. We checked three things:
- The fee schedule. In the HFS Practitioner Fee Schedule effective July 1, 2026 (updated September 15, 2026), 97802, 97803, 97804, G0270 and G0271 all carry indicator 09. The fee schedule key defines 09 as "Qualified Medicare Beneficiary (QMB) coverage only."
- Provider types. We found no dietitian provider type in HFS's notices or handbooks.
- Legislation. Bills to add MNT by licensed dietitians have been filed but haven't passed.
That's the state's fee-for-service program. Illinois' managed care plans (HealthChoice Illinois) can offer benefits beyond it, so the answer for a specific member can differ.
What "QMB coverage only" means
A Qualified Medicare Beneficiary has Medicare, with Medicaid helping pay Medicare's cost sharing. For those members, Medicare is the primary payer for MNT, under Medicare's own rules (diabetes or kidney disease, physician referral, 3 hours the first year and 2 after), and HFS's role is the crossover. For a Medicaid-only member, the MNT codes aren't a covered fee-for-service benefit. The Medicare side is covered in Medicare nutrition counseling.
What Illinois Medicaid does cover: DSMES
The closest covered service is diabetes self-management education and support (DSMES), which HFS added in 2021. Per the August 2021 provider notice and its July 2022 update:
- Who bills: a Diabetes Self-Management Education and Support Organization (Legacy PT 103), accredited by the Association of Diabetes Care & Education Specialists (ADCES) or recognized by the American Diabetes Association (ADA). It's an organizational enrollment, not an individual dietitian one.
- Who qualifies: the 2021 notice describes adults 18–64 with type 1, type 2 or gestational diabetes.
- What it includes: counseling on long-term dietary change, physical activity and weight-control strategies, diabetes self-care skills, and nutritional counseling services.
- How much: up to 18 hours per 12 months from the first training date: up to 3 hours individual and 15 hours group.
- Codes: G0108 (individual, per 30 minutes) and G0109 (group, per 30 minutes). The 2021 notice lists $55 per unit for G0108.
- Referral: as of the 2022 update, no formal referral is needed; the service only has to be recommended by a physician or other licensed practitioner, and HFS doesn't require the ordering NPI on the claim.
- Telehealth: modifier 93 (audio-only) and POS 10 (patient's home) are billable from July 1, 2022.
If you're a dietitian who wants to reach Illinois Medicaid members with diabetes, working with or building an accredited DSMES program is the published path. Code details: G0108 and G0109.
Pending legislation
- HB3434 (104th General Assembly), "Medicaid-Nutrition Therapy," would amend the Illinois Public Aid Code to cover MNT by licensed registered dietitians. Its last action, on March 21, 2025, re-referred it to the House Rules Committee (bill status).
- SB2374, "DHFS-Medical Nutrition Pilot," would create a medical nutrition pilot program. It was re-referred to the Senate Assignments Committee on May 22, 2026.
Neither is law. We'll update this page if either passes.
Managed care (HealthChoice Illinois)
Most Illinois Medicaid members are enrolled in a HealthChoice Illinois managed care plan. Plans can add value-added benefits beyond fee-for-service, and some contract with dietitians. We didn't find primary-source plan policies to cite, so ask the member's plan directly:
- Do you cover 97802/97803 by a registered dietitian for this member?
- Do you credential individual dietitians?
- Is a referral or authorization required, and how many visits?
Options for Illinois dietitians and patients
- Commercial and Medicare patients are where most Illinois private-practice MNT is billed. See the coverage by payer hub.
- Self-pay: before seeing a Medicaid member on a cash basis, know the rules. Providers can't balance bill Medicaid members for covered services, and HFS and plan rules govern charging for non-covered services. Get written, informed agreement first. Our superbill guide and cash pay vs insurance cover the mechanics.
Not legal or billing advice. HFS updates its fee schedules and notices; check the current versions and the member's plan before billing.