Oscar Health MNT coverage: codes, limits and referrals
The short answerOscar covers 97802, 97803, G0270 and G0271 when criteria are met. A licensed provider must prescribe it for a condition where diet has a proven role (diabetes, prediabetes, heart disease, high blood pressure, high cholesterol, eating disorders, malnutrition, pregnancy conditions, weight by BMI). It does not cover vegetarian, vegan or other specialty diet requests.
By Javier Alvarez · Updated · 1 min read
1 row: Oscar Health. Public policy, not the member's benefits.
Oscar Health
Oscar Clinical Guideline CG010, Medical Nutrition Therapy · All states
| 97802 | Listed (medically necessary if clinical criteria are met) [1] |
|---|---|
| 97803 | Listed (medically necessary if clinical criteria are met) [1] |
| G0270 | Listed (medically necessary if clinical criteria are met) [1] |
| G0271 | Listed (medically necessary if clinical criteria are met) [1] |
| Where it applies | Guideline CG010 Ver. 12, last revised 08/01/2026. The guideline says clinical guidelines apply according to policy and plan type, and coverage depends on the member's policy and applicable state and federal law. [1] |
| Diagnoses | Allowed ICD-10 ranges include E00.0 to E89.89 (endocrine, nutritional and metabolic), F50 eating disorders, I10 hypertensive diseases, I20 to I25 ischemic heart disease, I50 heart failure, J44 COPD, K-chapter digestive conditions, N18.6, O-chapter pregnancy conditions, R73.03 prediabetes and Z68 BMI codes. [1] |
| Other codes | Also listed as medically necessary if criteria are met: 97804, G0108, G0109, G0447, G0473 and S9470. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | The guideline sets no visit cap. Continued evaluation and counseling need documented changes in condition or regimen, adherence to the prescribed diet, evidence that more counseling would help, and measurable goals. [1] |
| Referral and prior auth | The therapy must be prescribed by a licensed healthcare provider, for a condition diagnosed by a licensed provider that threatens the member's general health. [1] |
| Who can bill | A licensed healthcare professional qualified to provide MNT. Examples named: Registered Dietitians (RD), RDNs, Certified Nutritionists (CNS or CCN), Licensed Dietitian-Nutritionists (LDN), and certain physicians with nutrition expertise. [1] |
| Also | Not medically necessary: MNT in an emergency room or urgent care setting, counseling for personal preference diets such as vegetarian, vegan, pescatarian or low-gluten, family history alone, and conditions not shown to be nutritionally related (examples: ADHD, asthma, autism spectrum disorder, chronic fatigue syndrome). [1] |
Check an Oscar Health claim against the row
Before an Oscar 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 Oscar Health with another payer, then download the PDF of what you see.