Insurance coverage · Coverage

Washington Apple Health nutrition counseling

By Javier Alvarez · Updated September 29, 2026 · 4 min read

The short answer

Washington is one of the states with a written, dietitian-specific Medicaid benefit. The Health Care Authority's Medical Nutrition Therapy Billing Guide (effective October 1, 2025) and chapter 182-555 WAC set the rules:

• A registered dietitian delivers the service and bills under their own HCA provider agreement.
• A physician, PA or ARNP refers the client.
• Children and young adults (20 and under) need no authorization.
• Adults (21 and older) qualify through four conditions and an expedited prior authorization (EPA) number, or through prior authorization.
• 97802, 97803 and 97804 have per-day, per-year and combined unit limits.

Who can bill

WAC 182-555-0400 says MNT must be delivered by a registered dietitian who has a current core provider agreement with HCA and a national provider identifier (NPI). The WAC defines an RD as registered with the Academy of Nutrition and Dietetics and certified by the Washington State Department of Health. The billing guide adds that RDs licensed in Oregon may be assigned an HCA-certified dietitian ProviderOne ID.

Two practical notes from the guide:

• Don't mix providers on one claim. Don't bill MNT and non-dietitian professional services together on the same claim.
• WIC locations. MNT given at a WIC site is billable when an RD with an NPI provides it and it isn't a WIC service or WIC-funded.

If you're not enrolled yet, our credentialing guide walks through the order of steps, and NPI type 1 vs type 2 covers which NPI goes where.

Who is covered

Every client needs a referral from a physician, physician assistant or advanced registered nurse practitioner. Keep it in the chart; our guide to physician referrals has what to ask for.

Age 20 and under. No EPA or PA is needed, and the EPSDT rules in chapter 182-534 WAC apply. The guide says published limits under EPSDT may be exceeded after HCA reviews medical necessity.

Age 21 and older. The client must have one of these conditions to use the EPA:

• Body mass index of 30 kg/m² or higher
• Cardiovascular risk factors: hypertension, dyslipidemia, congestive heart failure
• Diabetes mellitus
• Chronic kidney disease

If the guidelines are met, bill with EPA #870001644 in the authorization field. If they're not, request prior authorization. HCA denies claims that are missing a required EPA number, or whose diagnosis or procedure doesn't match the EPA.

Codes, units and limits

Beyond the combined cap, submit a limitation extension request. Places of service in the guide are 11 (office), 12 (home) and 22 (outpatient hospital).

HCA's MNT fee schedule effective July 1, 2026 lists these maximum allowable fees, each marked "PA/EPA Required for Age 21 and Up":

Units come from documented minutes. See CPT 97802, CPT 97803 and the MNT units calculator.

Documentation HCA expects

Beyond the general record rules in WAC 182-502-0020, the guide lists:

• The referral from the provider
• A nutrition care process assessment: nutrition assessment, nutrition diagnosis with a PES statement, intervention, and monitoring and evaluation
• Correspondence with the referring provider
• Associated medical conditions and the medical need

The PES statement is required, so it's worth getting right. Our PES statement builder and PES statement examples help. For the EPA, you must also document how the adult guidelines were met.

Telehealth

The guide says telemedicine is covered under the MNT program and points to HCA's general telemedicine policy and audio-only code lists on its billing guides page. Check those lists for the current modifier and POS rules before billing an audio-only visit. General guidance: telehealth billing for dietitians.

Managed care

Most Apple Health clients are enrolled in an HCA-contracted managed care organization (MCO), and their services go through the MCO. Clients in managed care must see providers in the MCO's network; HCA's guide says an out-of-network provider needs approval from both the MCO and the client's primary care provider. MCOs can have their own authorization rules, so check each plan's provider manual.

How to verify an Apple Health client's benefits

1. Eligibility and plan: confirm the client's Apple Health coverage and whether they're fee-for-service or in an MCO (and which one). See 270/271 eligibility checks.
2. Referral: get it from a physician, PA or ARNP before the first visit.
3. Age and diagnosis: under 21, no authorization; 21 and over, confirm one of the four EPA conditions is documented, or request PA.
4. Units used: ask how many 97803/97804 units remain this calendar year.
5. MCO rules if the client is in managed care.
6. Record the rep's name, date and reference number (verification call script).

For dietitians: claim tips

• Put the EPA number on every adult claim that meets the guidelines.
• Watch the combined 96-unit cap across 97803 and 97804.
• One 97804 group hour per day. Two 30-minute units is the daily maximum.
• Bill MNT on its own claim, not with a physician's office visit.

Not legal or billing advice. HCA updates billing guides and fee schedules regularly; check the current versions and the client's MCO before billing.