MNT coverage by payer and state, with sources
The short answerWhat 10 payers and 11 state programs publish about MNT for dietitians: which of 97802, 97803, G0270 and G0271 each policy lists, the telehealth place of service and modifier, visit limits and referrals. Every fact links to its source and the day we checked it. Filter the rows you bill and download them as a PDF.
By Javier Alvarez · Updated · 2 min read
| Rows | 10 payers, plus 11 state rows that show when you pick a state or Medicaid |
|---|---|
| Codes | 97802, 97803, G0270, G0271, plus each policy's other codes |
| Sources | 57 public policies, fee schedules and manuals, each with the date we opened it |
| Format | This table, and a PDF of the rows you filter |
20 rows: All payers and states. Public policy, not the member's benefits.
Medicare
Original Medicare (Part B) · All states
| 97802 | Listed (once, for the first visit) [1] |
|---|---|
| 97803 | Listed (every later individual visit) [1] |
| G0270 | Listed (hours beyond the base, after a second referral in the same year) [1] |
| G0271 | Listed (group, after a second referral in the same year) [1] |
| Diagnoses | Diabetes and kidney disease, or a kidney transplant in the last 36 months. [2] |
| Telehealth POS | POS 02 or 10. POS 10 pays the non-facility rate. Patients can be at home through December 31, 2027. [3][4][5] |
| Telehealth modifier | 95 for audio and video, 93 for audio only. [3] |
| Visit limits | 3 hours the first calendar year, 2 hours each year after. Unused hours don't carry over. More hours need a second referral (G0270, G0271). [2][1] |
| Referral and prior auth | A referral from the treating doctor is required. [2] |
| Who can bill | Registered dietitians and nutrition professionals. Dietitians are eligible telehealth practitioners. [4] |
| Payment | 2026 national rate paid to a dietitian: $31.23 per unit of 97802, $26.97 per unit of 97803 or G0270. The patient pays nothing. [6][2] |
- CMS: Medicare Claims Processing Manual, Chapter 4, Section 300 (MNT codes, G0270/G0271, PDF), checked October 22, 2026
- Medicare.gov: Medical nutrition therapy services, checked October 22, 2026
- CMS: Change Request 13582 (POS 02 or 10 paired with modifier 95 or 93, PDF), checked October 22, 2026
- CMS MLN901705: Telehealth and Remote Patient Monitoring, December 2025 (PDF), checked October 22, 2026
- CMS: Telehealth FAQ, updated 10/8/2026 (home telehealth through Dec 31, 2027, PDF), checked October 22, 2026
- CMS: PFS Relative Value Files, RVU26D, checked October 22, 2026
Humana Medicare Advantage
Medicare Advantage · All states
| 97802 | Follows Medicare (our reading: no Humana MNT code list, so Original Medicare's codes apply; not on Humana's MA prior authorization list) [1][2] |
|---|---|
| 97803 | Follows Medicare (our reading: no Humana MNT code list, so Original Medicare's codes apply; not on Humana's MA prior authorization list) [1][2] |
| G0270 | Follows Medicare (our reading: no Humana MNT code list, so Original Medicare's codes apply; not on Humana's MA prior authorization list) [3][1] |
| G0271 | Follows Medicare (our reading: no Humana MNT code list, so Original Medicare's codes apply; not on Humana's MA prior authorization list) [3][1] |
| Diagnoses | Diabetes, chronic kidney disease or a kidney transplant in the last 36 months (the Original Medicare baseline, NCD 180.1). [2][3] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | 3 hours the first year, 2 hours each year after; more with a new referral (G0270, G0271). [3][2] |
| Referral and prior auth | Medicare's physician referral for MNT applies. HMO plans may require a Humana referral number on the claim (Box 23 or loop 2300 REF02); Humana doesn't require one on PPO plans. 97802 to 97804, G0270 and G0271 are not on the MA prior authorization list (eff. 07/01/2026). [4][1] |
| Payment | Humana's Medicare member page says Medicare may cover MNT at 100%, with no deductible or copay, for members who qualify. [3] |
| Medicare rules | Timely filing for Medicare lines: 1 year from the date of service (Humana 2026 provider manual). We found no separate Humana MNT policy. [4] |
- Humana: Medicare Advantage and D-SNP prior authorization and notification list, eff. 07/01/2026 (PDF), checked September 28, 2026
- CMS: NCD 180.1 Medical Nutrition Therapy, checked September 28, 2026
- Humana: Medical nutrition therapy (Medicare member page), checked September 28, 2026
- Humana: 2026 Provider Manual for physicians, hospitals and healthcare providers (PDF), checked September 28, 2026
Aetna
Commercial · All states
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Listed [1] |
| G0271 | Listed [1] |
| Diagnoses | E66.x obesity; E66.3 overweight and Z68.25 to Z68.29 only with a cardiovascular risk factor; Z68.30 to Z68.45; F50.x eating disorders. Diabetes, kidney disease, hypertension and GI disorders are named as covered conditions. Z71.3 is not in the coding section. [1] |
| Other codes | 97804, G0447, G0473 and S9470; 99401 to 99412 as related codes. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Weight-reduction counseling for adults with a BMI of 30 or more: up to 26 individual or group visits per 12 months, combined across providers. No general MNT visit limit in the policy; other limits are set by the plan. [2] |
| Referral and prior auth | "Some plans require referrals." The policy states no prior authorization. [1] |
- Aetna: Clinical Policy Bulletin 0049, Nutritional Counseling (last reviewed 03/10/2026), checked October 22, 2026
- Aetna: Clinical Policy Bulletin 0039, Weight Reduction Medications and Programs, checked October 22, 2026
UnitedHealthcare
Commercial and Individual Exchange · All states
| 97802 | Listed (on the preventive rows) [1] |
|---|---|
| 97803 | Listed (on the preventive rows) [1] |
| G0270 | Listed (on the preventive rows) [1] |
| G0271 | Listed (on the preventive rows) [1] |
| Diagnoses | Prediabetes row: R73.03, ages 35 to 70. Healthy diet row: one of the listed cardiovascular risk factor codes. Weight-loss row: Z68.30 to Z68.45, or E66.01, E66.09, E66.1, E66.2, E66.811 to E66.813, E66.89, E66.9, E88.82. Z71.3 is not on these lists. [1] |
| Other codes | 97804 and 99401 to 99404 on the preventive rows. S9470 is replaced by 97802 or 97803. [1][2] |
| Telehealth POS | POS 02 or 10, with live audio and video, for codes on UHC's Telehealth Eligible Services list. [3] |
| Telehealth modifier | Not required. UHC accepts 95, GT, GQ and G0 as informational. [3] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
- UnitedHealthcare: Preventive Care Services, MP.016.60, effective 10/01/2026 (PDF), checked October 22, 2026
- UnitedHealthcare: Replacement Codes Policy, Professional, 2026R0128A (PDF), checked October 22, 2026
- UnitedHealthcare: Telehealth/Virtual Health Policy, Professional, 2026R0046A (PDF), checked October 22, 2026
Cigna
Commercial · All states
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Not named (not on A004's preventive list; may pay under the medical benefit) [1] |
| G0271 | Not named (not on A004's preventive list; may pay under the medical benefit) [1] |
| Diagnoses | A wellness code from Code Group 1 (includes Z71.3) for the preventive rows: adults with cardiovascular risk factors, adults and children 6 and older with obesity, and midlife women. An illness or injury diagnosis goes to the medical benefit. 97802 to 97804 and S9470 are also preventive with a maternity diagnosis code for pregnant members. [1] |
| Other codes | 97804 and S9470; 99401 to 99404, 99411 and 99412 allowed with any diagnosis. [1] |
| Telehealth POS | POS 02. Cigna's system accepts POS 10 but asks providers not to bill it "until further notice". [2] |
| Telehealth modifier | 95, GT or GQ. Paid at 100% of face-to-face rates when the requirements are met. [2] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
- Cigna: Administrative Policy A004, Preventive Care Services, effective 10/1/2026 (PDF), checked October 22, 2026
- Cigna: Virtual care billing guidance for commercial plans (updated 08/23/2022), checked October 22, 2026
Anthem Blue Cross and Blue Shield
Commercial · CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, WI
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Listed [1] |
| G0271 | Listed [1] |
| Where it applies | Anthem's commercial plans in CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA and WI. Other Blue plans publish their own policies. [1] |
| Diagnoses | Obesity rows: primary Z71.3, Z72.3 or Z72.4; secondary Z68.30 to Z68.45 or E66.01, E66.09, E66.1, E66.8, E66.9. Healthy diet row: Z71.3 or Z83.42 when the counseling is outside a preventive visit. [1] |
| Other codes | 97804 and S9470; 99401 to 99404. [1] |
| Telehealth POS | POS 02 or 10, for a code in CPT Appendix P. Professional virtual visits are "eligible for non-office place of service reimbursement". [2] |
| Telehealth modifier | 95 or GT for audio and video; 93 or FQ for audio only. [2] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
- Anthem Blue Cross and Blue Shield: ACA preventive care coding guidelines, commercial, August 2026 (PDF), checked October 22, 2026
- Anthem: Commercial Reimbursement Policy C-08002, Virtual Visits, approved 03/26/2026 (PDF), checked October 22, 2026
Florida Blue
All lines of business, with exceptions · Florida
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Listed [1] |
| G0271 | Listed [1] |
| Where it applies | All Florida Blue lines of business, under contracts that include MNT and preventive benefits. The Federal Employee Program and State Account Organization follow their own guidelines; Medicare Advantage follows NCD 180.1. [1] |
| Diagnoses | Medically necessary "for any appropriate diagnosis", for example diabetes, cardiovascular disease, renal disease, HIV, obesity and eating disorders. [1] |
| Other codes | 97804 and S9470. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | 3 hours in the first calendar year, 2 hours in later years, with a physician referral. More hours may be covered when medically necessary, such as a change in diagnosis or condition. [1] |
| Referral and prior auth | Referred by the treating physician. [1] |
| Who can bill | Payable when billed by a registered dietitian or nutrition professional. Not paid "incident to" physician services. [1] |
| Also | MNT and diabetes self-management training can be received in the same period but not billed on the same date of service. [1] |
Highmark
Commercial and Medicare Advantage · PA, WV, DE, NY
| 97802 | Listed (once for a new patient) [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Listed [1] |
| G0271 | Listed [1] |
| Where it applies | Commercial and Medicare Advantage in Highmark's Pennsylvania, West Virginia, Delaware and New York markets. [1] |
| Diagnoses | The Pennsylvania policy names conditions, not codes: diabetes, lipid disorders, cardiovascular and kidney conditions, GI disorders, nutritional deficiencies and others. Obesity is covered "per the member's group or individual benefit program". [2] |
| Other codes | 97804. The Pennsylvania medical policy also lists 99402 to 99404 for preventive counseling. [1][2] |
| Telehealth POS | POS 02 outside the home, POS 10 in the home, on 1500 claims. Paid at parity with in-person visits. [3] |
| Telehealth modifier | The policy names GT, 93 or 95 for facility claims only. [3] |
| Visit limits | The policies state none as of October 22, 2026. One MNT code per date of service, and modifiers don't bypass that edit. [1][2] |
| Referral and prior auth | Not published: call the payer. |
| Who can bill | A registered dietitian or nutrition professional, or a facility with their assignment. Anyone else is denied, and the denial can't be billed to the member. [1] |
- Highmark: Reimbursement Policy RP-076, Medical Nutrition Therapy, checked October 22, 2026
- Highmark: Commercial Medical Policy V-44-017, Medical Nutrition Management Services (Pennsylvania), checked October 22, 2026
- Highmark: Reimbursement Policy RP-046, Telemedicine and Telehealth Services (version effective 09/01/2026), checked October 22, 2026
TRICARE
TRICARE East and West · All states
| 97802 | Listed [1][2] |
|---|---|
| 97803 | Listed [1][2] |
| G0270 | Listed [1][2] |
| G0271 | Listed [1][2] |
| Diagnoses | East policy: obesity (BMI 30 or more in adults, 95th percentile in children), diabetes, renal disease, cardiovascular risk factors, medically necessary foods, ketogenic diet for epilepsy, eating disorders and cystic fibrosis. Counseling for general wellness is not covered. [1][3] |
| Other codes | 97804, G0447, G0473 and S9470. [1][2] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Diabetes and renal disease: 3 hours the first year, 2 hours after, more case by case. Obesity interventions: 12 to 26 sessions a year. [1][2] |
| Referral and prior auth | Not published: call the payer. |
| Who can bill | A TRICARE-authorized registered dietitian, licensed in the state, under a supervising physician. [1][3] |
- Humana Military (TRICARE East): Medical Coverage Policy MP21-003E, Nutritional Counseling (PDF), checked September 28, 2026
- TriWest (TRICARE West): Policy Key T-5, Nutrition Counseling Services, revised 6/30/2026 (PDF), checked September 28, 2026
- TRICARE: Nutritionist or Dietitian Services (covered services), checked September 28, 2026
Kaiser Permanente
HMO (integrated system) · CA, CO, WA
| 97802 | Not published |
|---|---|
| 97803 | Not published |
| G0270 | Not published |
| G0271 | Not published |
| Diagnoses | Not published: call the payer. |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Washington: nutritional counseling is authorized up to 6 visits per 12 months; request it within 14 days of the start. [1] |
| Referral and prior auth | An outside dietitian is paid only with an approved KP referral or authorization. Northern California HMO: prior authorization is a condition of payment for non-emergency outpatient services. [2] |
| Also | Colorado: in-house adult and pediatric weight management and nutrition services; one visit per referral unless the referral says otherwise. [3] |
- Kaiser Permanente Washington: Provider Manual 2026 (PDF), checked September 28, 2026
- Kaiser Permanente: 2026 Northern California HMO Provider Manual (PDF), checked September 28, 2026
- Kaiser Permanente Colorado: Affiliated Provider Manual 2026, Section 4 Utilization Management (PDF), checked September 28, 2026
Medi-Cal (California Medicaid)
Medicaid fee-for-service and managed care · California
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Not published |
| G0271 | Not published |
| Diagnoses | Not published: call the payer. |
| Other codes | 97804, in 30-minute units. [1] |
| Telehealth POS | POS 02 or 10. [2] |
| Telehealth modifier | 95 for video, 93 for audio only. [2] |
| Visit limits | Fee-for-service: 3 hours the first calendar year, 2 hours each later calendar year; more with a Treatment Authorization Request (TAR). 97802 to 97804 can't be billed on the same date as DSMT (G0108, G0109). [1] |
| Referral and prior auth | Not published: call the payer. |
| Managed care plans | Plan-specific. For example, Partnership HealthPlan pays up to 12 hours of 97803 per rolling 12 months without a TAR. [3] |
- DHCS: Medi-Cal Provider Manual, Medicine: Nutrition Counseling, updated Oct 2025 (PDF), checked September 28, 2026
- DHCS: Medi-Cal Provider Manual, Telehealth Modalities, updated Nov 2025 (PDF), checked September 28, 2026
- Partnership HealthPlan of California: MCUP3052 Medical Nutrition Therapy Services (PDF), checked September 28, 2026
Georgia Medicaid
Children's Intervention Services · Georgia
| 97802 | Listed (with modifier HA) [1] |
|---|---|
| 97803 | Listed (with modifiers HA and TS) [1] |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Children's Intervention Services: members from birth to 21 with a physical disability or developmental delay. No dietitian MNT benefit for adults was found in the current manuals. [1] |
| Diagnoses | Not published: call the payer. |
| Other codes | 97804 with modifier HA. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | 97802-HA: 1 visit a year; 97803-HA-TS: 12 visits a year; 97804-HA: 12 visits a year. [1] |
| Referral and prior auth | A PCP letter of medical necessity or a PCP-approved plan of care, and the PCP's NPI on every claim. Prior authorization past 8 units per month per specialty; not needed for evaluations. [1] |
| Who can bill | A Georgia-licensed dietitian enrolled as an individual provider. [1] |
| Payment | Maximum allowable: 97802 $28.09; 97803 $23.94; 97804 $13.00. [1] |
- Georgia DCH: Part II Policies and Procedures for Children's Intervention Services (CIS), July 1, 2026 (PDF), checked September 28, 2026
Illinois Medicaid
Medicaid (HFS) · Illinois
| 97802 | Limited (indicator 09: QMB coverage only) [1][2] |
|---|---|
| 97803 | Limited (indicator 09: QMB coverage only) [1][2] |
| G0270 | Limited (indicator 09: QMB coverage only) [1][2] |
| G0271 | Limited (indicator 09: QMB coverage only) [1][2] |
| Diagnoses | Not published: call the payer. |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
| Who can bill | No dietitian provider type found. [1] |
| Also | Covered alternative: DSMES (G0108, G0109) by ADCES-accredited or ADA-recognized organizations, up to 18 hours per 12 months (3 individual, 15 group). [3] |
- Illinois HFS: Practitioner Fee Schedule, eff. 07/01/2026, updated 09/15/2026 (PDF), checked September 28, 2026
- Illinois HFS: Practitioner Fee Schedule key, eff. 07/01/2026 (PDF), checked September 28, 2026
- Illinois HFS: Provider notice, updates to diabetes management programs (Jul 29, 2022), checked September 28, 2026
MassHealth (Massachusetts Medicaid)
MassHealth · Massachusetts
| 97802 | Listed [1][2] |
|---|---|
| 97803 | Listed [1][2] |
| G0270 | Listed [1][2] |
| G0271 | Listed [1][2] |
| Diagnoses | Nutritional diagnostic therapy and counseling to manage a medical condition; no diagnosis list in the regulation. [1] |
| Other codes | 97804; DSMT G0108 and G0109 for prediabetes or diabetes. [1][2] |
| Telehealth POS | POS 02 or 10. [3] |
| Telehealth modifier | 95, 93 or GQ. [3] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
| Who can bill | Community health centers, physicians, hospital outpatient departments, and independently enrolled nurse practitioners and nurse-midwives. No MassHealth provider type for independent dietitian billing was found. [1][2] |
- Massachusetts: 130 CMR 405.000 Community Health Center Services, incl. 405.475 Medical Nutrition Therapy (PDF), checked September 28, 2026
- MassHealth: Physician Bulletin 86, Medical Nutrition Therapy and Diabetes Self-Management Training (July 2007), checked September 28, 2026
- MassHealth: All Provider Bulletin 379, telehealth (Oct 2023), checked September 28, 2026
New York Medicaid
Fee-for-service and Medicaid Managed Care · New York
| 97802 | Listed (15-minute units) [1] |
|---|---|
| 97803 | Listed (15-minute units) [1] |
| G0270 | Not published |
| G0271 | Not published |
| Diagnoses | Not published: call the payer. |
| Other codes | 97804, in 30-minute units. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Recommended by a licensed practitioner acting within their scope (physicians, PAs, NPs, certified dietitians/nutritionists and others). [1] |
| Who can bill | Dietitians/nutritionists certified under NYS Education Law Article 157 and enrolled in NYS Medicaid, since January 1, 2024. [1][2] |
| Managed care plans | Medicaid Managed Care enrollees are covered too; contract with the plan, whose billing rules and fees apply. [2] |
- eMedNY: Dietitian/Nutritionist Policy Manual (effective Jan 1, 2024, PDF), checked September 28, 2026
- NYS DOH: Medicaid Update, December 2023: MNT services provided by qualified dietitians/nutritionists, checked September 28, 2026
NC Medicaid
Medicaid (Clinical Coverage Policy 1-I) · North Carolina
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Members under 21 with a qualifying condition; pregnant and postpartum women who meet the criteria. [1] |
| Diagnoses | Not published: call the payer. |
| Telehealth POS | The usual place of service. [1] |
| Telehealth modifier | GT for audio and video. Both codes are telehealth-eligible. [1] |
| Visit limits | 97802: 4 units per date of service and 4 units per 270 days. 97803: 4 units per date of service and 20 units per 365 days. Both across all providers. [1] |
| Referral and prior auth | No prior approval. An order or referral from the primary or specialty care provider is required. [1] |
| Who can bill | An NC-licensed dietitian/nutritionist or a CDR-registered dietitian, with their own NPI or their employer's. [1][2] |
- NC Medicaid: Clinical Coverage Policy 1-I, Dietary Evaluation and Counseling and Medical Lactation Services (PDF), checked September 28, 2026
- NC Medicaid: Registered Dieticians and Nutritionists Added to the List of Eligible Providers (Dec 2020), checked September 28, 2026
Ohio Medicaid
Medicaid (OAC 5160-8-41) · Ohio
| 97802 | Listed [1][2] |
|---|---|
| 97803 | Listed [1][2] |
| G0270 | Not published |
| G0271 | Not published |
| Diagnoses | The rule states no age limit and no diagnosis list. [1] |
| Other codes | 97804. Lactation consultation and DSMT are also covered services. [1] |
| Telehealth POS | The practitioner site's place of service. [3] |
| Telehealth modifier | GT, plus Ohio's patient-location modifier and the rendering NPI. [3] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
| Who can bill | Licensed and registered dietitians, independently or through a professional medical group, ambulatory health care clinic or FQHC/RHC. [1] |
| Payment | The lesser of your charge or the fee schedule: 97802 $22.84; 97803 $19.95; 97804 $9.97 (non-facility maximum, Appendix DD revised 07/01/2025). [1][2] |
- Ohio Administrative Code: Rule 5160-8-41, Services provided by a dietitian (eff. Oct 1, 2024), checked September 28, 2026
- Ohio Department of Medicaid: Appendix DD to rule 5160-1-60, Non-Institutional Fee Schedule, revised 07/01/2025 (PDF), checked September 28, 2026
- Ohio Administrative Code: Rule 5160-1-18, Telehealth, checked September 28, 2026
Pennsylvania Medicaid
Medical Assistance (fee-for-service) · Pennsylvania
| 97802 | Not listed (not on the MA outpatient fee schedule) [1] |
|---|---|
| 97803 | Not listed (not on the MA outpatient fee schedule) [1] |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Beneficiaries under 21 with weight management problems. No adult dietitian benefit was found. [2] |
| Diagnoses | Not published: call the payer. |
| Other codes | S9470 with modifiers U3 and TJ, one visit per day. [2] |
| Telehealth POS | The bulletin lists POS 11, 12 and 99; the online fee schedule also lists 02 and 10. [2][1] |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | No prior authorization. [2] |
| Who can bill | Provider Type 23 Nutritionist, specialty 230 (a Pennsylvania license and a dietetic registration card). [3] |
| Payment | $26.46 per visit for Provider Type 23. [1] |
- PA DHS: Medical Assistance Outpatient Fee Schedule search, checked September 28, 2026
- PA DHS: MA Bulletin 01-20-06/23-20-01 et al., Updates to Childhood Nutrition and Weight Management Services, May 26, 2020 (PDF), checked September 28, 2026
- PA DHS: Requirements for Provider Type 23, Nutritionist (PDF), checked September 28, 2026
Texas Medicaid
CCP and Healthy Texas Women · Texas
| 97802 | Listed (4 units per rolling year) [1][2] |
|---|---|
| 97803 | Listed (12 units per rolling year) [1][2] |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Comprehensive Care Program (CCP) clients 20 and under, and the Healthy Texas Women program. [1][2] |
| Diagnoses | In CCP, obesity alone is not a benefit without a comorbid condition. [1] |
| Other codes | 97804 (8 units per rolling year) and S9470 (4 visits per rolling year; in Healthy Texas Women, 1 visit a year without prior authorization). [1][2] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | 95 for synchronous audio and video; 93 for audio only where allowed. [1] |
| Visit limits | Per rolling year: 97802 4 units; 97803 12 units; 97804 8 units; S9470 4 visits. Healthy Texas Women uses the same unit limits. [1][2] |
| Referral and prior auth | CCP: prescribed by a physician. [1] |
| Managed care plans | Plans can add stricter rules. Community First Health Plans limits MNT to diabetes, renal disease and kidney transplant from August 3, 2026; that is its rule, not a statewide one. [3] |
- TMHP: TMPPM Children's Services Handbook, Medical Nutrition Counseling Services (CCP), Sept 2026 (PDF), checked September 28, 2026
- TMHP: TMPPM Healthy Texas Women Program Handbook, Sept 2026 (PDF), checked September 28, 2026
- Community First Health Plans: MNT coding and billing guidance (one Texas Medicaid plan, eff. Aug 3, 2026), checked September 28, 2026
Washington Apple Health (Medicaid)
Apple Health · Washington
| 97802 | Listed (8 units a year) [1] |
|---|---|
| 97803 | Listed (4 units a day) [1] |
| G0270 | Not published |
| G0271 | Not published |
| Diagnoses | 21 and older: BMI 30 or more, cardiovascular risk factors, diabetes or chronic kidney disease, billed with EPA #870001644; other adults need prior authorization. 20 and under: no EPA or PA, EPSDT rules apply. [1][2] |
| Other codes | 97804, 2 units a day. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | 97802: 8 units a year. 97803: 4 units a day. 97804: 2 units a day. 97803 and 97804 together: 96 units per calendar year. [1] |
| Referral and prior auth | Required, from a physician, PA or ARNP. [1][2] |
| Who can bill | A registered dietitian with an HCA core provider agreement and an NPI. [1] |
| Payment | Non-facility maximum allowable from July 1, 2026: 97802 $22.36, 97803 $19.30, 97804 $10.32. [3] |
- Washington HCA: Medical Nutrition Therapy Billing Guide, effective Oct 1, 2025 (PDF), checked September 28, 2026
- Washington State Legislature: Chapter 182-555 WAC, Medical nutrition therapy, checked September 28, 2026
- Washington HCA: Medical Nutrition Therapy fee schedule, effective July 1, 2026 (XLSX), checked September 28, 2026
How to use the table
Pick a payer, a state, a code or "telehealth rule published", and the table keeps only the rows that match. Open a row for every field and its numbered sources. Download my PDF saves exactly the rows you see, with the sources and the date we checked each one, to print or keep next to your billing.
A field that says "Not published: call the payer" is one the payer's public policies don't answer. That is the question to ask on the provider line.
Every payer and state on the table
- Payers: Medicare, Humana Medicare Advantage, Aetna, UnitedHealthcare, Cigna, Anthem Blue Cross and Blue Shield, Florida Blue, Highmark, TRICARE, Kaiser Permanente.
- Medicaid: Medicaid by state, and Medi-Cal (California Medicaid), Georgia Medicaid, Illinois Medicaid, MassHealth (Massachusetts Medicaid), New York Medicaid, NC Medicaid, Ohio Medicaid, Pennsylvania Medicaid, Texas Medicaid, Washington Apple Health (Medicaid).
- A payer in one state: Aetna in Texas.
Where the facts come from
Only from the payer's own public policy, fee schedule or provider manual, or from CMS for Medicare. Each fact links to its source and shows the day we opened it (October 30, 2026 for the latest). No source, no fact. Payers we couldn't find a public MNT policy for (Humana commercial, for example) aren't on the table yet.
For the claim itself, the MNT units calculator turns minutes into units and the denial checker reads the codes on a remittance. If you'd rather not file these claims yourself, Duo Practice files them for you for 3.9% of what is collected; see the billing service.
