Insurance coverage · Coverage
Ohio Medicaid nutrition counseling
By Javier Alvarez · Updated · 4 min read
| Governing rule | OAC 5160-8-41, Services provided by a dietitian (effective Oct 1, 2024) |
|---|---|
| Who can render | Licensed dietitians and registered dietitians (Ohio Revised Code Chapter 4759) |
| Who can be paid | Independent LD or RD, professional medical group, ambulatory health care clinic, FQHC/RHC |
| Covered services | CPT medical nutrition therapy; lactation consultation; DSMT |
| Fee schedule (Appendix DD, rev. 07/01/2025) | 97802 $22.84; 97803 $19.95; 97804 $9.97 (non-facility maximum) |
| Telehealth | Allowed (OAC 5160-1-18): GT modifier, practitioner-site POS, rendering NPI, patient-location modifier |
| Last verified | September 28, 2026 |
The short answer
Ohio is one of the more open Medicaid programs for dietitians. Ohio Administrative Code 5160-8-41, "Services provided by a dietitian" (effective October 1, 2024), does three things:
- Lets licensed dietitians and registered dietitians (as defined in Ohio Revised Code Chapter 4759) enroll in Medicaid as rendering providers.
- Lets an independent dietitian be the billing (pay-to) provider, or a medical group, ambulatory health care clinic, FQHC or RHC bill on the dietitian's behalf.
- Covers medical nutrition therapy services specified in CPT (97802, 97803, 97804), plus lactation consultation and diabetes self-management training.
The rule doesn't restrict MNT to children, to a program, or to a diagnosis list, which sets Ohio apart from states like Texas or North Carolina.
Who can bill
| Role | Who qualifies under 5160-8-41 |
|---|---|
| Rendering provider | Licensed dietitian; registered dietitian (ORC Chapter 4759) |
| Pay-to provider | Independent licensed dietitian; independent registered dietitian; professional medical group; ambulatory health care clinic; FQHC or RHC |
If you're in private practice, you can enroll as an independent pay-to provider and bill with your own NPI. If you work for a group or clinic, it can bill for your services. In an FQHC or RHC, payment follows those centers' own rules (Chapter 5160-28), not the fee schedule below.
Enrollment comes first, then contracts with the managed care plans your patients use. Our credentialing guide walks through the order.
Codes and payment
Payment outside FQHCs and RHCs is the lesser of your submitted charge or the amount in Appendix DD to rule 5160-1-60. The Appendix DD fee schedule revised July 1, 2025 lists:
| Code | Description in the schedule | Current maximum, non-facility | Current maximum, facility |
|---|---|---|---|
| 97802 | Medical nutrition, individual, initial | $22.84 | $18.77 |
| 97803 | Medical nutrition, individual, subsequent | $19.95 | $16.06 |
| 97804 | Medical nutrition, group | $9.97 | $8.61 |
| S9470 | Prenatal nutrition counseling, dietitian visit | $27.95 | $26.62 |
The same MNT codes with modifier TH are listed as lactation counseling by a dietitian. G0270 and G0271 aren't on the schedule. ODM revises Appendix DD periodically, so confirm the current version before you set expectations with a practice budget. Our dietitian reimbursement rates post puts Medicaid rates in context.
Units are 15 minutes for 97802 and 97803 and 30 minutes for 97804, counted from documented time; see CPT 97802, CPT 97803 and the MNT units calculator.
Diagnoses, limits and authorization
Rule 5160-8-41 doesn't list qualifying diagnoses, age limits, unit caps or a prior authorization requirement. That doesn't mean anything goes:
- Medical necessity still applies to every Medicaid service; document the condition you're treating and why nutrition therapy is part of it. See charting for medical necessity.
- Code what you documented. Diagnoses to the highest specificity, with BMI codes secondary; see ICD-10 codes for dietitians.
- Managed care plans can require referrals or prior authorization for their members. Most Ohio Medicaid members are in a managed care plan, so the plan's provider manual is where those rules live.
Telehealth
OAC 5160-1-18 lists dietitians among eligible telehealth practitioners and medical nutrition services (along with lactation consultation and DSMT) among services payable by telehealth. Unless the billing guidelines say otherwise, professional telehealth claims must include:
- Modifier GT
- A place of service code for where the practitioner is, not the patient
- The rendering provider's NPI
- A patient-location modifier from the rule's appendix B when the patient is at home, at school, in a hospital, a nursing facility or an ICF-IID
That combination differs from the 95-modifier, POS 10 convention many commercial payers use, so don't copy your commercial telehealth claims. The rule also expects at least one in-person annual visit (or a referral for one) when you've treated someone only by telehealth for more than twelve consecutive months. Background: telehealth billing for dietitians.
How to verify an Ohio Medicaid member's benefits
- Eligibility and plan: fee-for-service or which managed care plan. See 270/271 eligibility checks.
- Your enrollment and network status with ODM and the member's plan.
- The plan's rules: referral, prior authorization or visit limits for 97802/97803.
- Telehealth: the plan's modifier and POS expectations, if you'll see the member virtually.
- Record the rep's name, date and reference number (verification call script).
For dietitians: claim tips
- Enroll as the right pay-to type: independent LD/RD if you bill yourself.
- Use GT plus the patient-location modifier on telehealth claims.
- Use TH only for lactation counseling, not for MNT.
- Check the current Appendix DD before quoting rates; ODM revises it.
Not legal or billing advice. Ohio Medicaid rules, fee schedules and plan policies change; check the current rule, appendix and the member's plan before billing.