CareFirst BlueCross BlueShield MNT coverage: codes and who can bill
The short answerCareFirst covers medically necessary professional nutritional counseling and medical nutrition therapy as determined by CareFirst. Counseling must come from a licensed dietitian-nutritionist, physician, PA or NP. Its BlueChoice manual points to medical policy 2.01.050A (CPT 97802 to 97804), which was not found online. No visit limits are published.
By Javier Alvarez · Updated · 1 min read
1 row: CareFirst BlueCross BlueShield. Public policy, not the member's benefits.
CareFirst BlueCross BlueShield
BlueChoice provider manual and a DC small group PPO benefit book · MD, DC, VA
| 97802 | Listed (the BlueChoice manual refers to medical nutritional therapy as CPT 97802 to 97804 under medical policy operating procedure 2.01.050A.) [1] |
|---|---|
| 97803 | Listed (the BlueChoice manual refers to medical nutritional therapy as CPT 97802 to 97804 under medical policy operating procedure 2.01.050A.) [1] |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | CareFirst BlueChoice products (provider manual section, file dated October 2023) and a 2026 DC small group (SHOP) PPO benefit book from Group Hospitalization and Medical Services. Benefits vary by contract, jurisdiction and product. Maryland and northern Virginia contracts were not checked directly. [1][2] |
| Diagnoses | Counseling is for people at nutritional risk because of nutritional history, current dietary intake, medication use or a chronic illness or condition. MNT treats a chronic illness or condition. [1][2] |
| Other codes | 97804 is named with 97802 and 97803 in the same reference. [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 | Not published: call the payer. |
| Who can bill | Professional Nutritional Counseling must be provided by a licensed dietitian-nutritionist, physician, physician assistant or nurse practitioner (benefit book). The manual says counseling is provided by a registered licensed dietitian or other health professional within their scope of practice. [2][1] |
| Payment | Benefits are available for Medically Necessary Professional Nutritional Counseling and Medical Nutrition Therapy as determined by CareFirst. [2] |
| Also | The manual refers to medical policy operating procedure 2.01.050A for details and to the CareFirst Preventive Services Guidelines for diet and exercise counseling in preventive visits. Neither document was found publicly. [1] |
Check a CareFirst BlueCross BlueShield claim against the row
Before a CareFirst BlueCross BlueShield 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 CareFirst BlueCross BlueShield with another payer, then download the PDF of what you see.