99401-99404 with Blue Cross Blue Shield of Massachusetts: what the policy says
By Javier Alvarez · Updated · 2 min read
1 row: Blue Cross Blue Shield of Massachusetts. Public policy, not the member's benefits.
Blue Cross Blue Shield of Massachusetts
ACA Preventive Care Services Billing Guideline (Feb. 2025) and authorization table (July 2026) · Massachusetts
| 97802 | Limited (listed as preventive coded services (ACA billing guideline). Diagnostic MNT is not addressed in the public documents found.) [1] |
|---|---|
| 97803 | Limited (listed as preventive coded services (ACA billing guideline). Diagnostic MNT is not addressed in the public documents found.) [1] |
| G0270 | Limited (listed as preventive coded services (ACA billing guideline). Diagnostic MNT is not addressed in the public documents found.) [1] |
| G0271 | Limited (listed as preventive coded services (ACA billing guideline). Diagnostic MNT is not addressed in the public documents found.) [1] |
| Where it applies | ACA preventive services for non-grandfathered plans, current as of February 2025. The authorization table is current as of July 2026 and covers several products. [1][2] |
| Diagnoses | Diet and physical activity counseling to prevent cardiovascular disease: adults who are overweight or obese and have additional cardiovascular risk factors and/or abnormal blood glucose. Obesity screening and counseling: children, adolescents and adults. [1] |
| Other codes | 97804 and S9470 are in the same rows. The obesity row also lists S9482. [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 | The authorization table (rev. 07/26) lists Nutritional Counseling as not requiring authorization for any listed product. For Commercial HMO/POS members, authorization is required for out-of-network care (Out-of-Network Request Form). [2] |
| Payment | Members pay no additional cost for listed codes from in-network providers. Preventive, screening and counseling diagnosis codes should be billed in the primary position because benefits are based on the primary diagnosis. [1] |
- Blue Cross Blue Shield of Massachusetts: Patient Protection and Affordable Care Act Preventive Care Services Billing Guideline (current as of February 2025), checked October 30, 2026
- Blue Cross Blue Shield of Massachusetts: Authorization requirements by product (current as of July 2026), checked October 30, 2026
What Blue Cross Blue Shield of Massachusetts' policy says about 99401-99404
99401-99404 is the CPT code for preventive medicine counseling, 15 to 60 minutes. At Blue Cross Blue Shield of Massachusetts it is limited: paid only in a narrow case, see the note. Each line below is from Blue Cross Blue Shield of Massachusetts' own text:
- Where it is listed. 99402 to 99404 are in the cardiovascular diet counseling row and the obesity screening and counseling row (children, adolescents and adults). 99401 is not in either row. (Blue Cross Blue Shield of Massachusetts, checked October 30, 2026)
- When it pays. In the HIV PrEP row 99401 is shown as "covered but not separately reimbursed", while 99402 to 99404 are listed. (Blue Cross Blue Shield of Massachusetts, checked October 30, 2026)
- Diagnosis position. BCBSMA says diagnosis codes for preventive and counseling services go in the primary position because benefits are based on the primary diagnosis. (Blue Cross Blue Shield of Massachusetts, checked October 30, 2026)
99401-99404 at other payers
- 99401-99404 with BCBS of IL, TX, OK and NM (HCSC): limited.
- 99401-99404 with Blue Cross NC: listed.
- 99401-99404 with UnitedHealthcare: listed.
- 99401-99404 with Cigna: listed.
- 99401-99404 with Anthem Blue Cross and Blue Shield: listed.
The rest of Blue Cross Blue Shield of Massachusetts' MNT rules
The Blue Cross Blue Shield of Massachusetts row has its codes, telehealth rule, limits and referrals, each with its source. Other codes we checked at Blue Cross Blue Shield of Massachusetts: G0447. What 99401-99404 means at any payer is on the 99401-99404 code page. Before the claim goes out, compare it with the row in the table above, then download the PDF of what you see.