Aetna in Texas MNT coverage: codes, telehealth and limits
The short answerIn Texas, Aetna publishes the telehealth rule its national policy leaves out. For fully insured commercial plans under Texas Insurance Code Chapter 1455, bill POS 02 and/or the modifier, with 95 for real-time audio and video, and telehealth counts as face-to-face when the standard of care is met. The codes and diagnoses come from Aetna's national policy.
By Javier Alvarez · Updated · 1 min read
1 row: Aetna · Texas. Public policy, not the member's benefits.
Aetna in Texas
Commercial, fully insured · Texas
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Listed [1] |
| G0271 | Listed [1] |
| Where it applies | In-network Texas providers treating members of fully insured commercial plans subject to Texas Insurance Code Chapter 1455 (in effect since January 1, 2018). Self-funded plans, Medicare and Medicaid are not covered by this page. [2] |
| 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 | POS 02 and/or the applicable modifier, with an eligible CPT or HCPCS code. There are no telemedicine-specific CPT codes. [2] |
| Telehealth modifier | 95 for synchronous (real-time) audio and video. The page also lists GT, labeled for an asynchronous telecommunications system, with which you certify the visit used an interactive audio and video system. [2] |
| Telehealth rules | Treated as face-to-face when the standard of care is met, and the service must be covered under the member's plan. Audio-only calls, text-only email and fax are not required to be covered. [2] |
| 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. [3] |
| 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: Texas telemedicine, teledentistry and telehealth services (TIC Chapter 1455), checked October 30, 2026
- Aetna: Clinical Policy Bulletin 0039, Weight Reduction Medications and Programs, checked October 22, 2026
What changes for Aetna in Texas
The codes, diagnoses and limits on this page are Aetna's national rules from the Aetna page. What Texas adds, from Aetna:
- Where it applies. In-network Texas providers treating members of fully insured commercial plans subject to Texas Insurance Code Chapter 1455 (in effect since January 1, 2018). Self-funded plans, Medicare and Medicaid are not covered by this page.
- Telehealth place of service. POS 02 and/or the applicable modifier, with an eligible CPT or HCPCS code. There are no telemedicine-specific CPT codes.
- Telehealth modifier. 95 for synchronous (real-time) audio and video. The page also lists GT, labeled for an asynchronous telecommunications system, with which you certify the visit used an interactive audio and video system.
- Telehealth rules. Treated as face-to-face when the standard of care is met, and the service must be covered under the member's plan. Audio-only calls, text-only email and fax are not required to be covered.
Check an Aetna claim against the row
Before an Aetna in Texas claim goes out, compare it with the row above: the code is one the policy lists, the place of service and modifier match for a video visit, and the units fit the limit. Change the filters to compare Aetna with another payer, then download the PDF of what you see. More on the Aetna coverage guide and the one-page Aetna code sheet.