97802 with BCBS of IL, TX, OK and NM (HCSC): what the policy says
The short answerHCSC names 97802 in five preventive counseling rows. Two of them (prediabetes, midlife women) pay only with a code in Diagnosis List 1, which does not print Z71.3, E66 or any Z68 code.
By Javier Alvarez · Updated · 2 min read
1 row: HCSC. Public policy, not the member's benefits.
BCBS of IL, TX, OK and NM (HCSC)
HCSC Preventive Services Policy RP006 (commercial, effective April 1, 2026) · IL, TX, OK, NM
| 97802 | Limited (named in the preventive services grid (USPSTF and HRSA counseling rows). The policy does not describe diagnostic MNT billing.) [1] |
|---|---|
| 97803 | Limited (named in the preventive services grid (USPSTF and HRSA counseling rows). The policy does not describe diagnostic MNT billing.) [1] |
| G0270 | Limited (named in the preventive services grid (USPSTF and HRSA counseling rows). The policy does not describe diagnostic MNT billing.) [1] |
| G0271 | Limited (named in the preventive services grid (USPSTF and HRSA counseling rows). The policy does not describe diagnostic MNT billing.) [1] |
| Where it applies | Commercial plans of Blue Cross and Blue Shield of Illinois, Texas, Oklahoma and New Mexico, all divisions of HCSC. The Texas, Illinois, Oklahoma and New Mexico editions of RP006 (effective April 1, 2026) carry the same text. A Montana edition was not found. Plan documents and provider contracts override the policy. [1][2][3][4] |
| Diagnoses | Adults with a BMI of 30 or higher (weight loss row, 97802 to 97804). Adults with cardiovascular risk factors (diet counseling row, lists 97802, 97803, 97804, G0270, G0271, S9470). Prediabetes and midlife women aged 40 to 60 rows pay only with a code in "Diagnosis List 1". Diagnosis List 1 is printed at the end of the policy; it includes R73.03 and Z71.41 but not Z71.3, E66 or Z68 codes. [1] |
| Other codes | 97804 (group MNT) and S9470 appear in the same preventive rows. [1] |
| Telehealth POS | Illinois edition of the telemedicine policy (CPCP033, Sept. 26, 2025): telehealth professional claims on a CMS-1500 use POS 02 or 10. Not nutrition specific. Texas, Oklahoma and New Mexico editions were not checked. [5] |
| Telehealth modifier | Illinois edition of CPCP033: modifiers FQ, FR, G0, GT, 93 and 95 go on the code when the code is not a telemedicine specific code. Not nutrition specific. [5] |
| Telehealth rules | The Texas Telemedicine Code List (updated March 25, 2026) includes 97802, 97803, 97804, G0270, G0271 and S9470. A matching list for the other states was not found. [6] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
| Payment | For preventive level payment with no member cost share, the claim must include a preventive diagnosis code and a preventive procedure code, meet medical policy review criteria and fall within USPSTF, ACIP, HRSA or Bright Futures guidelines. Out of network preventive care is not guaranteed at no cost share. [1] |
| Also | The policy separates preventive from diagnostic care. Its example of diagnostic care is a patient diagnosed with diabetes referred for nutritional counseling. Services not payable at the preventive level may be payable under another part of the medical plan. [1] |
- Blue Cross and Blue Shield of Texas (HCSC): RP006 Preventive Services Policy (effective April 1, 2026), checked October 30, 2026
- Blue Cross and Blue Shield of Illinois (HCSC): RP006 Preventive Services Policy (effective April 1, 2026), checked October 30, 2026
- Blue Cross and Blue Shield of Oklahoma (HCSC): RP006 Preventive Services Policy (effective April 1, 2026), checked October 30, 2026
- Blue Cross and Blue Shield of New Mexico (HCSC): RP006 Preventive Services Policy (effective April 1, 2026), checked October 30, 2026
- Blue Cross and Blue Shield of Illinois: CPCP033 Telemedicine and Telehealth/Virtual Health Care Services Policy (effective Sept. 26, 2025), checked October 30, 2026
- Blue Cross and Blue Shield of Texas: Telemedicine Code List (effective Jan. 1, 2022, updated March 25, 2026), checked October 30, 2026
What BCBS of IL, TX, OK and NM (HCSC)'s policy says about 97802
97802 is the CPT code for medical nutrition therapy, initial assessment, individual. At BCBS of IL, TX, OK and NM (HCSC) it is limited: paid only in a narrow case, see the note. Each line below is from HCSC's own text:
- Where it is listed. 97802 appears in five rows of the preventive services grid: diet counseling for adults with cardiovascular risk factors, weight loss for adults with a BMI of 30 or higher, obesity in children and adolescents (6 years and older), prediabetes and type 2 diabetes screening, and obesity prevention in midlife women aged 40 to 60. (Blue Cross and Blue Shield of Texas (HCSC), checked October 30, 2026)
- Billed with. Diagnosis List 1 is printed at the end of the grid. It includes R73.03 (prediabetes) but does not include Z71.3, any E66 code or any Z68 code. (Blue Cross and Blue Shield of Texas (HCSC), checked October 30, 2026)
- When it pays. The prediabetes row and the midlife women row say "Payable with a diagnosis code in Diagnosis List 1". The other three rows print no diagnosis condition. (Blue Cross and Blue Shield of Texas (HCSC), checked October 30, 2026)
- Also. The policy says many listed services may be performed for other indications. Then they may be covered by another provision of the plan and be subject to cost sharing. (Blue Cross and Blue Shield of Texas (HCSC), checked October 30, 2026)
97802 at other payers
- 97802 with Blue Cross NC: listed.
- 97802 with Medicare: listed.
The rest of BCBS of IL, TX, OK and NM (HCSC)'s MNT rules
The BCBS of IL, TX, OK and NM (HCSC) row has its codes, telehealth rule, limits and referrals, each with its source. Other codes we checked at BCBS of IL, TX, OK and NM (HCSC): G0270, G0447 and 99401-99404. What 97802 means at any payer is on the 97802 code page. Before the claim goes out, compare it with the row in the table above, then download the PDF of what you see.