PacificSource MNT coverage: codes, limits and referrals
The short answerPacificSource covers dietary or nutritional counseling for diabetes education, eating disorders, inborn errors of metabolism and obesity when a provider refers. Prior authorization is needed only for diagnoses not listed. It lists 97802, 97803, 97804 and S9470.
By Javier Alvarez · Updated · 1 min read
1 row: PacificSource. Public policy, not the member's benefits.
PacificSource
Dietary or Nutritional Counseling clinical guideline · ID, MT, OR, WA
| 97802 | Listed (listed in coding information.) [1] |
|---|---|
| 97803 | Listed (listed in coding information.) [1] |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Applies to PacificSource health plans in Idaho, Montana, Oregon and Washington. Commercial policy shows OPs 8/2023. Member benefit book governs limits. [1] |
| Diagnoses | Covered for diabetes education, eating disorders (F50 codes), inborn errors of metabolism and obesity. Women aged 40 to 60 with normal or overweight body mass may be covered under HRSA guidelines. [1] |
| Other codes | 97804 (group) and S9470 (Nutritional counseling, dietitian visit) are also listed. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Prior authorization is only required for diagnoses not listed in the guideline or any other indication, including those outlined by HRSA guidelines. [1] |
| Referral and prior auth | Counseling is covered when referred by a health care provider and delivered by a qualified licensed health professional trained in nutrition, such as a Registered Dietitian. [1] |
- PacificSource: Dietary or Nutritional Counseling clinical guideline (commercial OPs 8/2023), checked October 30, 2026
Check a PacificSource claim against the row
Before a PacificSource 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 PacificSource with another payer, then download the PDF of what you see.