97803 with UnitedHealthcare: what the policy says
By Javier Alvarez · Updated · 2 min read
1 row: UnitedHealthcare. Public policy, not the member's benefits.
UnitedHealthcare
Commercial and Individual Exchange · All states
| 97802 | Listed (on the preventive rows) [1] |
|---|---|
| 97803 | Listed (on the preventive rows) [1] |
| G0270 | Listed (on the preventive rows) [1] |
| G0271 | Listed (on the preventive rows) [1] |
| Diagnoses | Prediabetes row: R73.03, ages 35 to 70. Healthy diet row: one of the listed cardiovascular risk factor codes. Weight-loss row: Z68.30 to Z68.45, or E66.01, E66.09, E66.1, E66.2, E66.811 to E66.813, E66.89, E66.9, E88.82. Z71.3 is not on these lists. [1] |
| Other codes | 97804 and 99401 to 99404 on the preventive rows. S9470 is replaced by 97802 or 97803. [1][2] |
| Telehealth POS | POS 02 or 10, with live audio and video, for codes on UHC's Telehealth Eligible Services list. [3] |
| Telehealth modifier | Not required. UHC accepts 95, GT, GQ and G0 as informational. [3] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
- UnitedHealthcare: Preventive Care Services, commercial and individual exchange medical policy (effective 10/01/2026), checked October 30, 2026
- UnitedHealthcare: Replacement Codes Policy, Professional, 2026R0128A (PDF), checked October 22, 2026
- UnitedHealthcare: Telehealth/Virtual Health Policy, Professional, 2026R0046A (PDF), checked October 22, 2026
What UnitedHealthcare's policy says about 97803
97803 is the CPT code for medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes. At UnitedHealthcare it is listed: named in the payer's public policy. Each line below is from UnitedHealthcare's own text:
- Where it is listed. 97803 sits in the Medical Nutrition Therapy list with 97802, 97804, G0270 and G0271 on the pre-diabetes, cardiovascular risk factor, adult weight loss, high BMI in children and pregnancy weight rows. (UnitedHealthcare, checked October 30, 2026)
- Billed with. On the weight loss and child high BMI rows, 97803 needs one of that row's diagnosis codes. On the pre-diabetes row it needs R73.03. (UnitedHealthcare, checked October 30, 2026)
- When it pays. Pre-diabetes row: ages 35 to 70 only, ending on the 71st birthday, with R73.03. (UnitedHealthcare, checked October 30, 2026)
- Diagnosis position. The listed diagnosis does not have to be primary, or the only diagnosis, on the claim. Only a few services (breast cancer chemoprevention counseling, BRCA, HIV prevention) need the primary position. (UnitedHealthcare, checked October 30, 2026)
- Also. The policy warns that certain codes may not be payable in all circumstances because of other policies or guidelines. (UnitedHealthcare, checked October 30, 2026)
97803 at other payers
- 97803 with Anthem Blue Cross and Blue Shield: listed.
- 97803 with Medicare: listed.
The rest of UnitedHealthcare's MNT rules
The UnitedHealthcare row has its codes, telehealth rule, limits and referrals, each with its source. Other codes we checked at UnitedHealthcare: E66, Z68, R73.03, G0447 and 99401-99404. What 97803 means at any payer is on the 97803 code page. Before the claim goes out, compare it with the row in the table above, then download the PDF of what you see.