Insurance coverage · Coverage
North Carolina Medicaid nutrition counseling
By Javier Alvarez · Updated · 5 min read
| Governing policy | NC Medicaid Clinical Coverage Policy 1-I, Dietary Evaluation and Counseling (amended Aug 15, 2023) |
|---|---|
| Who is covered | Members under 21 with a qualifying condition; pregnant and postpartum women meeting the criteria |
| Who can bill | NC-licensed dietitian/nutritionist or CDR-registered dietitian, own NPI or employer's |
| Codes | 97802, 97803 (both telehealth-eligible); hospital outpatient RC 942 |
| 97802 limit | 4 units per date of service; 4 units per 270 days, any provider |
| 97803 limit | 4 units per date of service; 20 units per 365 days, any provider |
| Prior approval | Not required; order or referral from the primary or specialty care provider is |
| Telehealth | Modifier GT for audio-video; usual place of service |
| Last verified | September 28, 2026 |
The short answer
North Carolina Medicaid pays registered and licensed dietitians directly, but for a defined population. Clinical Coverage Policy 1-I, "Dietary Evaluation and Counseling and Medical Lactation Services" (amended August 15, 2023), covers:
- Members under 21 with a chronic, episodic or acute condition for which nutrition therapy is a critical part of medical management.
- Pregnant and postpartum women whose pregnancy is threatened by such a condition, or who need follow-up after delivery.
Adults outside pregnancy aren't covered by this policy. Within it, there's no prior approval, but you need an order or referral, and 97802 and 97803 have unit limits that count across all providers.
Who can bill
Since July 26, 2020, NC Medicaid lets registered dietitians and nutritionists enroll and bill for this service, per its December 2020 announcement. Policy 1-I section 6.1 says the service must be performed by:
- A dietitian or nutritionist currently licensed by the N.C. Board of Dietetics and Nutrition (a provisional license isn't acceptable), or
- A registered dietitian currently registered with the Commission on Dietetic Registration (registration eligibility isn't acceptable).
The policy lists the dietitian and nutrition taxonomies it recognizes, from Dietitian, Registered (133V00000X) to Nutritionist (133N00000X), including pediatric, renal and obesity specialties. Enrolled dietitians may bill with their own NPI or under their employer's NPI. Medicaid-enrolled organizations that employ or contract with dietitians, such as health departments, physician practices and outpatient hospitals, can bill for the service too.
New to enrollment? Start with insurance credentialing step by step and NPI type 1 vs type 2.
Who is covered
Members under 21
The member needs a condition for which nutrition therapy is critical, including any one of these (section 3.2.1, summarized):
- Inappropriate growth or weight gain: inadequate gain, weight loss, underweight, obesity, short stature
- Nutritional anemia
- Eating or feeding disorders that cause a medical condition
- Physical or genetic conditions that affect growth and feeding (cleft palate, cerebral palsy, cystic fibrosis, Down syndrome)
- Chronic medical conditions such as cancer, cardiac disease, hypertension, hyperlipidemia, GI, liver, pulmonary or renal disease, significant food allergies
- Metabolic and endocrine disorders, including diabetes and inborn errors of metabolism
- Metabolic syndrome, or a first-degree family history of cardiovascular disease or significant CVD risk factors
Claims for members 0–20 "are not limited to a specific diagnosis" (Attachment A). EPSDT also applies: the policy says limits may be exceeded when documentation shows the service is medically necessary to correct or ameliorate a condition.
Pregnant and postpartum women
Covered conditions include severe anemia, inadequate weight gain, intrauterine growth restriction, very young maternal age, multiple gestation, substance use, diabetes and other metabolic disorders, chronic conditions such as hypertension or renal disease, eating disorders, and obesity only when the BMI thresholds in section 3.2.2(f) are met. For members 21 and older, one of the primary ICD-10-CM codes listed in Attachment A (mostly O09.x supervision of high-risk pregnancy and Z34.x normal pregnancy, plus a few others) must be used.
Codes and limits
| Code | Telehealth-eligible | Limit (section 5.3.2) |
|---|---|---|
| 97802 initial assessment | Yes | 4 units per date of service; no more than 4 units per 270 calendar days, same or different provider |
| 97803 re-assessment | Yes | 4 units per date of service; no more than 20 units per 365 calendar days, same or different provider |
The service must be individual and face-to-face with the member or caretaker. 97804 (group) isn't on the policy's code list. Hospital outpatient clinics bill revenue code 942. Units come from the documented minutes; see CPT 97802, CPT 97803 and the 8-minute rule.
"Same or a different provider" matters: another dietitian's units in the window count against yours. Ask about prior units before the first visit.
Order, referral and documentation
- No prior approval: section 5.1 says Medicaid "shall not require prior approval" for dietary evaluation and counseling.
- Order or referral: section 7.2 requires the record to contain the member's primary care or specialty care provider's order for the service or referral. See physician referrals for dietitians.
- WIC: anyone categorically eligible for WIC must be referred there for routine nutrition education and food supplements. Policy 1-I itself covers disease-related counseling.
Telehealth
Both codes are telehealth-eligible. Policy 1-I says telehealth services must follow Clinical Coverage Policy 1-H, that modifier GT must be appended for interactive audio-visual services, and that telehealth claims should use the provider's usual place of service code. That differs from the 95 modifier and POS 10 most commercial payers use; see telehealth billing for dietitians. Re-check 1-H before billing, because telehealth rules change more often than this policy.
Managed care (health plans)
Most NC Medicaid members are enrolled in a health plan (a Prepaid Health Plan, or PHP), and the policy tells members to contact their PHP about benefits. Plans can publish their own versions. WellCare of North Carolina's policy WNC.CP.210 follows policy 1-I's criteria and the same 4-per-270 and 20-per-365 unit limits. Contract with each plan your patients use.
How to verify an NC Medicaid member's benefits
- Eligibility and plan in NCTracks or the health plan's portal. See 270/271 eligibility checks.
- Population: under 21, or pregnant/postpartum with a qualifying condition?
- Order or referral on file from the primary or specialty care provider.
- Prior units of 97802 (270 days) and 97803 (365 days), from any provider.
- The health plan's own policy and your network status with it.
- Record the rep's name, date and reference number (verification call script).
For dietitians: claim tips
- Bill 97802 once per 270-day window, up to 4 units.
- Use GT, not 95, on telehealth claims unless your health plan says otherwise.
- Adult pregnancy claims need a listed primary diagnosis, usually from O09.x or Z34.x.
- Obesity alone in pregnancy qualifies only at the policy's BMI thresholds.
Not legal or billing advice. NC Medicaid amends clinical coverage policies; check the current version of 1-I and 1-H and the member's health plan before billing.