99401-99404 with Blue Cross NC: what the policy says
The short answerBlue Cross NC lists 99401 to 99404 in many preventive rows and says they are "to be used in the absence of a wellness visit". The cardiovascular diet counseling row lists only 99402 to 99404.
By Javier Alvarez · Updated · 2 min read
1 row: Blue Cross and Blue Shield of North Carolina. Public policy, not the member's benefits.
Blue Cross NC
Commercial reimbursement policies (Bundling Guidelines, Telehealth) and preventive coding guide · North Carolina
| 97802 | Listed (named on the commercial telehealth code list and in the preventive services coding guide.) [1][2] |
|---|---|
| 97803 | Listed (named on the commercial telehealth code list and in the preventive services coding guide.) [1][2] |
| G0270 | Listed (named on the commercial telehealth code list and in the preventive services coding guide.) [1][2] |
| G0271 | Listed (named on the commercial telehealth code list and in the preventive services coding guide.) [1][2] |
| Where it applies | Commercial lines. The Bundling Guidelines (last review 06/2025) and Telehealth policy (last review 09/2025) are Blue Cross NC Commercial Reimbursement Policies. The coding guide covers non-grandfathered health plans. [3][1][2] |
| Diagnoses | In the preventive coding guide, the diet and physical activity counseling row for adults with cardiovascular risk factors lists 97802, 97803, 97804, S9452, S9470, G0270, G0271 and diagnosis Z71.3. The guide says 99402 to 99404 are used in the absence of a wellness visit. [2] |
| Other codes | 97804 (group MNT) is on the same telehealth list. S9470 appears in the preventive coding guide rows. [1][2] |
| Telehealth POS | Telehealth services must be reported with POS 02 (not in the patient's home) or POS 10 (in the patient's home). [1] |
| Telehealth modifier | Modifier 95 identifies synchronous audio and video telemedicine. Audio only telehealth, shown by modifier FQ or 93, receives 75% of the allowed reimbursement. Asynchronous services or modifier GQ are not reimbursable. [1] |
| Telehealth rules | The telehealth code list includes 97802, 97803, 97804, G0270 and G0271. Providers must be eligible to independently perform and bill the equivalent face to face service. Facilities are not eligible for telehealth reimbursement. [1] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
| Who can bill | MNT is not reimbursable when billed by a provider other than a registered dietician, nutritional professional or hospital. Other specialty providers doing MNT are not eligible. [3] |
| Also | MNT is not eligible for separate reimbursement when dialysis services are reimbursed in the same month. [3] |
- Blue Cross NC: Telehealth, Commercial Reimbursement Policy (last review 09/2025), checked October 30, 2026
- Blue Cross NC: Health Care Reform Preventive Services Coding Guide, checked October 30, 2026
- Blue Cross NC: Bundling Guidelines, Commercial Reimbursement Policy (last review 06/2025), checked October 30, 2026
What Blue Cross NC's policy says about 99401-99404
99401-99404 is the CPT code for preventive medicine counseling, 15 to 60 minutes. At Blue Cross NC it is listed: named in the payer's public policy. Each line below is from Blue Cross and Blue Shield of North Carolina's own text:
- Where it is listed. 99401 to 99404 appear in the adult obesity row, the children's obesity row and several other counseling rows. The cardiovascular diet counseling and pregnancy weight gain rows list 99402 to 99404 only. (Blue Cross NC, checked October 30, 2026)
- Billed with. In the adult obesity row they pair with G0447 or G0473 and diagnoses E66.9, E66.01, E66.09, E66.1, E66.8 and Z68.30 to Z68.45. In the cardiovascular row they pair with 97802 to 97804 and diagnosis Z71.3. (Blue Cross NC, checked October 30, 2026)
- When it pays. Rows say 99401-99404 or 99402-99404 "are to be used in the absence of a wellness visit". (Blue Cross NC, checked October 30, 2026)
- Diagnosis position. The guide says services must be billed with the appropriate diagnosis at the line level and that a well-person diagnosis should be the primary diagnosis. (Blue Cross NC, 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 Blue Shield of Massachusetts: limited.
- 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 NC's MNT rules
The Blue Cross NC row has its codes, telehealth rule, limits and referrals, each with its source. Other codes we checked at Blue Cross NC: Z71.3, E66, Z68 and 97802. 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.