New Jersey Medicaid MNT coverage: codes and referrals
The short answerNew Jersey's approved State Plan (SPA 18-0003, effective 7/1/2018) covers nutritional counseling as a preventive diabetes service for NJ FamilyCare members, delivered by registered dietitians or Certified Nutrition Specialists on a practitioner recommendation. It does not name CPT codes; rates sit in the state fee schedule.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · New Jersey. Public policy, not the member's benefits.
New Jersey Medicaid
Medicaid (State Plan, Diabetes Services) · New Jersey
| 97802 | Not named (state Plan does not name CPT codes) [1] |
|---|---|
| 97803 | Not named (state Plan does not name CPT codes) [1] |
| G0270 | Not named [1] |
| G0271 | Not named [1] |
| Where it applies | Diabetes services are preventive services under 42 CFR 440.130(c). They include nutritional counseling, can be provided in the home, clinic, hospital outpatient facility or other authorized setting, and are for preventing diabetes or its progression. The same text applies to categorically and medically needy groups. [1] |
| Diagnoses | Not published: call the payer. |
| 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 | Services must be recommended by a physician or other licensed practitioner of the healing arts within their scope of practice. [1] |
| Who can bill | Nutritional counseling may be provided by Registered Dietitians (registered by a nationally recognized professional association) or Certified Nutrition Specialists. The individual must be a Medicaid/NJ FamilyCare provider or work for one, and hold a state license to practice independently and/or a national certification. [1] |
| Payment | Paid under the published Medicaid fee schedule, with codes and rates on njmmis.com under Rates and Code Information. The State Plan page 36 says the fee schedule rates were set July 1, 2018. [1] |
Check a Medicaid claim against the row
Before a New Jersey Medicaid 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 Medicaid with another payer, then download the PDF of what you see.