Insurance coverage · Coverage
New York Medicaid nutrition counseling
By Javier Alvarez · Updated · 4 min read
| Effective | January 1, 2024 (Medicaid Update, December 2023) |
|---|---|
| Who can bill | Dietitians/nutritionists certified under NYS Education Law Article 157, enrolled in NYS Medicaid |
| Members | Fee-for-service and Medicaid Managed Care (MMC) enrollees |
| Recommendation | By a licensed practitioner acting within scope (physicians, PAs, NPs, certified dietitians/nutritionists and others) |
| FFS codes | 97802, 97803 (15-min units), 97804 (30-min units) |
| Managed care | Contract with the MMC plan; its billing rules and fees apply |
| Last verified | September 28, 2026 |
The short answer
New York is one of the clearest Medicaid programs for dietitians. The December 2023 Medicaid Update announced, and the eMedNY Dietitian/Nutritionist Policy Manual codifies, that effective January 1, 2024, qualified dietitians/nutritionists can enroll in NYS Medicaid and bill directly for medically necessary medical nutrition therapy (MNT), for:
- Fee-for-service (FFS) Medicaid members, and
- Medicaid Managed Care (MMC) enrollees, through contracts with the MMC plans.
Who qualifies
The manual defines the provider as a certified dietitian, certified dietician or certified nutritionist under Title 8, Article 157 of the New York Education Law (the CDN credential), or someone licensed by the appropriate agency in the state where they practice.
Certified dietitians/nutritionists working in an Article 28 facility (a hospital or clinic) enroll differently: as an Ordering/Prescribing/Referring/Attending (OPRA) provider affiliated with the facility, so the facility can bill for nutrition services.
The recommendation rule
The manual calls MNT a preventive health service. To be reimbursable, it must be recommended by a licensed practitioner of the healing arts acting within their scope of practice under state law. The manual's list of who can do that is broader than Medicare's: physicians, physician assistants, nurse practitioners, certified dietitians/nutritionists and other licensed practitioners able to determine and document medical necessity.
In practice: document who recommended MNT and why (the medical necessity) in the chart, and keep any referral you receive. Compare that with Medicare, which requires a referral from a treating MD or DO (Medicare nutrition counseling).
Codes for fee-for-service claims
| Code | What it is | Unit |
|---|---|---|
| 97802 | MNT, initial assessment and intervention, individual | Each 15 minutes |
| 97803 | MNT, re-assessment and intervention, individual | Each 15 minutes |
| 97804 | MNT, group (2 or more) | Each 30 minutes |
The manual and the Medicaid Update also publish FFS unit prices; check the current eMedNY fee schedule for today's amounts. Other codes that aren't nutrition-specific can apply, such as T1013 for sign-language or oral interpreter services.
Units follow the CPT time rule: count the documented face-to-face minutes of this visit. See the 8-minute rule for dietitians or use the MNT units calculator.
Managed care
Most New York Medicaid members are in an MMC plan. The Medicaid Update is explicit that the FFS billing instructions and fees are specific to FFS; for MMC enrollees, providers should follow the member's MMC plan for implementation details, reimbursement and billing instructions. That means:
- You need an MMC plan contract (credentialing) to be in network for its members.
- The plan can have its own rules on diagnosis, authorization, visit limits and telehealth.
- Questions about MMC members go to the plan, not eMedNY.
How to enroll
eMedNY's dietitian/nutritionist enrollment page offers the options the Medicaid Update described:
- Individual billing provider: you'll bill NYS Medicaid FFS directly.
- Non-billing OPRA or Managed Care Network Provider: you won't bill FFS, but you need Medicaid enrollment to order, refer or contract with MMC plans.
- Change from non-billing to billing if you start with option 2.
Medicaid enrollment must be revalidated every five years. For the broader process (NPI, CAQH, payer applications), see insurance credentialing step by step.
Limits and telehealth
The Dietitian/Nutritionist Policy Manual doesn't set a visit or unit limit, and doesn't address telehealth specifically. New York's general Medicaid telehealth policy and each MMC plan's rules govern virtual visits. Before you bill a video visit, confirm the place of service and modifier the program or plan expects; general guidance is in telehealth billing for dietitians.
How to verify a NY Medicaid member's coverage
- Check eligibility through ePACES or your clearinghouse, and see whether the member is FFS or in an MMC plan (and which one).
- FFS member: confirm you're enrolled as a billing provider, and that the MNT recommendation is documented.
- MMC member: confirm you're contracted with that plan; ask the plan whether 97802/97803 need prior authorization, whether there's a visit limit, and how it wants telehealth billed.
- Record the answers with the rep's name, date and reference number (verification call script).
For dietitians: claim tips
- Enroll first. FFS enrollment (billing or non-billing) comes before any MMC contract.
- Document the recommendation and medical necessity in every chart.
- Bill units from minutes, 97802 for the initial assessment and 97803 after.
- For MMC members, follow the plan's manual, not the FFS instructions.
- For how New York compares with other states, see Medicaid nutrition counseling.
Not legal or billing advice. Check the current eMedNY manual and the member's plan before billing.