Moda Health MNT coverage: codes and referrals
The short answerModa covers medical nutrition therapy as medically necessary for obesity in children and adults, underweight with failure to thrive, and eating disorders. The criteria list 97802, 97803 and 97804. Moda describes a prior authorization submission.
By Javier Alvarez · Updated · 1 min read
1 row: Moda Health. Public policy, not the member's benefits.
Moda Health
Medical Nutrition Therapy medical necessity criteria · OR, AK
| 97802 | Listed (listed under codes covered.) [1] |
|---|---|
| 97803 | Listed (listed under codes covered.) [1] |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Criteria CWQI HCS-0263, effective 07/01/2026, last reviewed 06/24/2026. [1] |
| Diagnoses | Children 6 to 17 at the 85th percentile BMI or higher; adults with BMI 30 or more, or BMI 25 to 29.9 with hypertension, dyslipidemia, impaired fasting glucose or metabolic syndrome; BMI under 18.5 with failure to thrive; and eating disorder diagnoses F50.00 to F50.9. [1] |
| Other codes | 97804 (group, each 30 minutes) is also listed as covered. [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 | The underweight criterion needs a prescription by a physician or a provider such as a licensed nutritionist, registered dietitian or trained nurse. The criteria describe documentation submitted with the prior authorization request. [1] |
| Managed care plans | Eating disorder requests should be submitted to Moda Behavioral Health for review. [1] |
- Moda Health: Medical Nutrition Therapy medical necessity criteria (effective 07/01/2026), checked October 30, 2026
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