Wisconsin Medicaid MNT coverage: codes and limits
The short answerThe Wisconsin ForwardHealth policy we found pays for 97802-97804 only as part of medically tailored meals, for BadgerCare Plus and Medicaid SSI HMO members with high-risk pregnancy, or diabetes or heart disease after a hospital stay. It is not available in fee-for-service. We found no general dietitian MNT benefit.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Wisconsin. Public policy, not the member's benefits.
Wisconsin Medicaid
Medicaid (ForwardHealth, Food Is Medicine / medically tailored meals) · Wisconsin
| 97802 | Limited (only for medically tailored meals, with modifier U1, U2 or U3) [1] |
|---|---|
| 97803 | Limited (only for medically tailored meals, with modifier U1, U2 or U3) [1] |
| G0270 | Not named [1] |
| G0271 | Not named [1] |
| Where it applies | Medically tailored meals are an in lieu of service that participating BadgerCare Plus and Medicaid SSI HMOs can choose to offer, starting January 1, 2025. They are not covered in fee-for-service Medicaid or Family Care, IRIS, PACE or CLTS. [2][1] |
| Diagnoses | Members with a high-risk pregnancy or high-risk postpartum, diabetes after a hospital discharge in the past 90 days, or cardiovascular disease after a hospital discharge in the past 90 days. Modifiers: U1 for pregnancy or postpartum, U2 for diabetes, U3 for cardiovascular disease. [2][1] |
| Other codes | 97804 (group, each 30 minutes) and S9470 (nutritional counseling, dietitian visit, for real-time audio-only telehealth), also with U1, U2 and/or U3. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Telehealth rules | The dietitian visit may be in person or by real-time, interactive audio-visual or audio-only telehealth. Use S9470 for audio-only visits. [2][1] |
| Visit limits | Meal reimbursement covers up to two meals per day for up to 12 weeks, and includes any assessments with the dietitian. HMOs may reauthorize every 12 weeks for up to one year. [2] |
| Referral and prior auth | Not published: call the payer. |
| Who can bill | The dietitian must hold a Wisconsin license and be employed by or contracted with a Food Is Medicine provider, but does not need to be individually enrolled as a Wisconsin Medicaid provider. The Food Is Medicine provider bills the HMO. [2][1] |
| Managed care plans | Food Is Medicine providers must have a contract with at least one participating BadgerCare Plus or Medicaid SSI HMO. HMOs may add claim requirements. [1][2] |
Check a Medicaid claim against the row
Before a Wisconsin 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.