Illinois insurance law on MNT and nutrition counseling
The short answerIllinois requires group accident and health policies to cover diabetes self-management training and education, including medical nutrition therapy as the Dietitian Nutritionist Practice Act defines it. Coverage is limited to 3 visits at diagnosis and 2 visits after a significant change.
By Javier Alvarez · Updated · 2 min read
1 row: State insurance law · Illinois. Public policy, not the member's benefits.
Illinois insurance law
Fully insured plans (215 ILCS 5/356w) · Illinois
| 97802 | Not published |
|---|---|
| 97803 | Not published |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Group policies of accident and health insurance amended, delivered, issued, or renewed after the 1998 amendatory Act. Covers type 1, type 2, and gestational diabetes mellitus. [1] |
| Diagnoses | Type 1 diabetes, type 2 diabetes, and gestational diabetes mellitus. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Up to 3 medically necessary visits to a qualified provider upon initial diagnosis, and up to 2 medically necessary visits after a physician determines a significant change in symptoms or condition. No coverage is required for additional visits. [1] |
| Referral and prior auth | A physician's diagnosis or determination of significant change triggers each visit allowance, and some plans require a referral to the qualified provider. [1] |
| Who can bill | A qualified provider: in an HMO with a primary care physician, the PCP, a referred physician, or a referred certified, registered, or licensed network professional with diabetes expertise. In other plans, a physician or a referred certified, registered, or licensed professional with diabetes expertise. Dietitians are not named. [1] |
| Also | Medical nutrition therapy has the meaning in the Dietitian Nutritionist Practice Act. Cost sharing is the same as for other services by the same type of provider. [1] |
- Illinois Compiled Statutes: 215 ILCS 5/356w Diabetes self-management training and education, checked October 30, 2026
What the Illinois law says
- Where it applies. Group policies of accident and health insurance amended, delivered, issued, or renewed after the 1998 amendatory Act. Covers type 1, type 2, and gestational diabetes mellitus.
- Diagnoses. Type 1 diabetes, type 2 diabetes, and gestational diabetes mellitus.
- Visit limits. Up to 3 medically necessary visits to a qualified provider upon initial diagnosis, and up to 2 medically necessary visits after a physician determines a significant change in symptoms or condition. No coverage is required for additional visits.
- Referral and prior auth. A physician's diagnosis or determination of significant change triggers each visit allowance, and some plans require a referral to the qualified provider.
- Who can bill. A qualified provider: in an HMO with a primary care physician, the PCP, a referred physician, or a referred certified, registered, or licensed network professional with diabetes expertise. In other plans, a physician or a referred certified, registered, or licensed professional with diabetes expertise. Dietitians are not named.
- Also. Medical nutrition therapy has the meaning in the Dietitian Nutritionist Practice Act. Cost sharing is the same as for other services by the same type of provider.
What it means for a claim in Illinois
The law sets a floor for the plans it reaches; the plan's own policy and the member's contract still decide the codes, units and referral. On the benefits call, ask whether the plan is fully insured in Illinois, and if a covered service is denied, name the statute by section in the appeal. The sources below link to the statute itself.
Payers with their own row for Illinois: Illinois Medicaid and BCBS of IL, TX, OK and NM (HCSC). The state laws side by side compare Illinois with other states.