RetiredBlue Cross Blue Shield of VermontPolicy 10.01.VT205

Nutritional Counseling Corporate Medical Policy

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This policy governs when nutritional counseling and medical nutrition therapy may be medically necessary, which providers may furnish the services, and the applicable procedure codes and prior-approval requirements. It applies to BCBS Vermont members subject to their applicable contract and benefit terms.

Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyNutritional Counseling Corporate Medical Policy

Policy CodePolicy 10.01.VT205

Change TypeRetired and replaced

Effective DateAugust 1, 2026

Last ReviewApr 1, 2026

Next Review DateN/A

Key ActionObtain prior approval for HCPCS G0270 before providing the service.

SourceLink

POLICY UPDATE CHANGES

The policy was replaced by a new medical policy named Medical Nutrition Therapy/Nutritional Counseling.

3medical-necessity pathways described

No limitnutritional counseling visits per member per plan year

1procedure code requiring prior approval

8distinct procedure, HCPCS, and revenue-code values listed

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RetiredBlue Cross Blue Shield of VermontPolicy 10.01.VT205

Nutritional Counseling Corporate Medical Policy

Customize your policy alerts

Sign up for bcbsvermont Policy 10.01.VT205 alerts

Get alerted when Policy 10.01.VT205 changes without checking for updates manually.

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Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyNutritional Counseling Corporate Medical Policy

Policy CodePolicy 10.01.VT205

Change TypeRetired and replaced

Effective DateAugust 1, 2026

Last ReviewApr 1, 2026

Next Review DateN/A

Key ActionObtain prior approval for HCPCS G0270 before providing the service.

SourceLink

POLICY UPDATE CHANGES

The policy was replaced by a new medical policy named Medical Nutrition Therapy/Nutritional Counseling.

3medical-necessity pathways described

No limitnutritional counseling visits per member per plan year

1procedure code requiring prior approval

8distinct procedure, HCPCS, and revenue-code values listed

Medical Necessity and Visit Limits

Medical Necessity for Nutritional Counseling

Medical Nutrition Therapy may be medically necessary when ANY of the following pathways is met:

Qualifying medical-necessity pathways

Chronic disease with therapeutic dietary role: The individual has a chronic disease in which dietary adjustment has a therapeutic role.
Examples include eating disorders, metabolic syndrome, coronary artery disease, hyperlipidemia, chronic kidney disease, hypertension, prediabetes, and diabetes.
Obesity: The individual is a child or adult who is obese.
Overweight adult with chronic disease: The individual is an adult who is overweight and has a chronic disease.
Both overweight status and chronic disease are required for this pathway.

Visit Limits

Visit frequency:

No annual visit limit: There is no limit on the number of visits for nutritional counseling per member per plan year.No limit

Applicable benefit terms and contract limitations still apply.

Covered Procedure and Revenue Codes

CPT codes—prior approval not requiredCPTCovered

97802	Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
97803	Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
97804	Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes; medical nutrition therapy; reassessment.

HCPCS code—prior approval requiredHCPCSCovered

G0270

Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen, including additional hours needed for renal disease, individual, face-to-face with the patient, each 15 minutes.

HCPCS codes—prior approval not requiredHCPCSCovered

G0271	Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen, group (2 or more individuals), each 30 minutes.
S9452	Nutrition classes, non-physician provider, per session.
S9470	Nutritional counseling, dietitian visit.

Revenue coding—prior approval not requiredmixedCovered

S9470	Nutritional counseling, dietitian visit.
0942	Revenue code associated with nutritional counseling, dietitian visit.

Authorization and Provider Requirements

Prior Authorization

Obtain prior approval for G0270

Prior approval is required for HCPCS G0270 when billing medical nutrition therapy reassessment and subsequent interventions following a second referral in the same year for a change in diagnosis, medical condition, or treatment regimen, including additional hours needed for renal disease.

Documentation Required

Use qualified providers

Services must be furnished by qualified healthcare professionals practicing within the scope of their license(s).

Denial Risk

Nutritional Counseling Background

Nutritional counseling provides individualized dietary guidance to members at nutritional risk because of their nutritional history, current dietary intake, medication use, or chronic illness. Counseling considers factors such as food intake, physical activity, medical treatment, medications, and individual preferences to support improved nutritional status.

Key Definitions

Metabolic diseases

DefinitionHereditary diseases or disorders that disrupt normal metabolism, the process of converting food to energy at a cellular level.

Cellular impactThey affect the ability of cells to perform critical biochemical reactions.

Examples of substances affectedThese reactions involve processing or transporting proteins (amino acids), carbohydrates (sugars and starches), or lipids (fatty acids).

Eating disorders

DefinitionPersistent disturbances of eating that impair health or psychosocial functioning.

Included disordersAnorexia nervosa; avoidant/restrictive food intake disorder; binge eating disorder; bulimia nervosa; pica; and rumination disorder.