Fallon Health MNT coverage: codes, telehealth and limits
The short answerFallon pays 97802, 97803, 97804, G0270 and G0271 for MNT by participating licensed professionals. No PCP referral or prior authorization is needed, but the referring physician's name and NPI must be on the claim. NaviCare and Fallon Medicare Plus cap it at 3 one-on-one visits a year. The policy is dated 2021.
By Javier Alvarez · Updated · 1 min read
1 row: Fallon Health. Public policy, not the member's benefits.
Fallon Health
Fallon Health and subsidiaries (MNT Payment Policy) · Massachusetts
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Listed [1] |
| G0271 | Listed [1] |
| Where it applies | Payment policy effective 01/01/2021, originally dated 07/21/04. It applies to Fallon Health and its subsidiaries, in all settings. It is the MNT policy still listed on Fallon's provider payment policies page. [1] |
| Diagnoses | Not published: call the payer. |
| Other codes | 97804 (group) is listed. S9470 was removed from the code list in 2009 as a non-covered code. [1] |
| Telehealth POS | The Community Care (Commercial and Exchange) telehealth policy, effective 06/01/2025, requires POS 02 or 10 on professional claims. [2] |
| Telehealth modifier | Modifier 95 is required on institutional telehealth claims. Modifier 93 may be used for audio-only services. [2] |
| Telehealth rules | Registered dieticians or nutrition professionals are listed as eligible telehealth providers. 97802, 97803, 97804 and G0270 appear in the policy's code table. Payment rates and cost-sharing match in-person services. [2] |
| Visit limits | For NaviCare and Fallon Medicare Plus, up to 3 total one-on-one visits each year for all members, Medicare-covered and non-Medicare-covered diagnoses. The policy states no cap for other products. [1] |
| Referral and prior auth | A PCP referral is not required for medical nutrition and prior authorization is not required. The referring physician's name and NPI must be submitted. [1] |
| Who can bill | Covered services come from licensed professionals participating through a contracted entity and within their scope of practice. The listed examples are RD, LMNT, CN, RDE and LDN. NaviCare and Fallon Medicare Plus members must see a registered dietitian or other nutrition professional in network. [1] |
| Payment | Payment for MNT by non-physician professionals is 85 percent of the applicable physician fee schedule amount, or as per contract. Diabetes self-management training is not paid on the same day as MNT. [1] |
- Fallon Health: Medical Nutrition Therapy Payment Policy (effective 01/01/2021), checked October 30, 2026
- Fallon Health: Telehealth Services, Community Care Payment Policy (effective 06/01/2025), checked October 30, 2026
Check a Fallon Health claim against the row
Before a Fallon Health 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 Fallon Health with another payer, then download the PDF of what you see.