CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

Provider Food Programs: Food Is Medicine Benefit for Pregnant Members with Diabetes

Defines coverage, provider requirements, and billing for home-delivered medically tailored meals and grocery boxes for pregnant New Mexico Medicaid members with diabetes. Applies to providers delivering the Food Is Medicine benefit and to Turquoise Care MCO referral processes.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyProvider Food Programs: Food Is Medicine Benefit for Pregnant Members with Diabetes

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionEnroll as New Mexico Medicaid Provider Type 346 and ensure claims include required identifiers (TIN, NPI, taxonomy, place of service) and appropriate diagnosis coding for diabetes and pregnancy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Up to 11 monthsmaximum coverage duration

Up to 2meals covered/day

346required provider type

diabetes + pregnancyrequired diagnosis coding

90 daysstandard filing window

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Coverage criteria and limits

Covered services and eligibility

Covered when ALL of the following are met

Member eligibility: Member is a pregnant Medicaid recipient with a diabetes diagnosis (type 1, type 2, or gestational)

Source: eligibility and purpose

Service type: Service is home-delivered medically tailored meals or medically tailored grocery boxes designed by a registered dietitian nutritionist to meet the nutritional requirements of pregnancy with diabetes

Includes prepared meals or grocery boxes defined by an RDN

Quantity & duration limits: Up to two meals per day for the member (or grocery-box nutritional equivalent), for up to 11 months and not to extend beyond two months postpartumUp to 2/day; up to 11 months; not beyond 2 months postpartum

Meal units and maximum coverage duration

Service exclusivity: Member may not receive multiple Food Is Medicine services at the same time

Benefit cannot be provided concurrently from multiple Food Is Medicine programs

Coordination with other nutrition supports: Food Is Medicine benefit must be coordinated with existing nutrition supports (e.g., SNAP or WIC); the benefit may supplement but not supplant these programs; if member is not enrolled in SNAP or WIC, the managed care organization must refer the member

Requirement to factor benefit into existing supports and referral obligation

Individualized meal planning: Individualized meal plans must be designed by an RDN in consultation with the member and must account for individual nutritional needs and cultural, religious, and personal preferences

RDN-designed plans in consultation with member

Members are not eligible to receive multiple Food Is Medicine services simultaneously. The benefit is intended to supplement, not supplant existing nutrition supports such as SNAP or WIC; managed care organizations must refer members to SNAP/WIC if the member is not already enrolled. Coordination decisions for members who qualify for multiple Medicaid meal programs should be made between the provider and the member’s provider or Home and Community‑Based Services case manager to determine the most appropriate way to meet the member’s needs.

Claims for Food Is Medicine should be filed within 90 days of the date of service as the standard filing window. If a primary carrier exists, providers must (1) file with the primary carrier within 180 days of the date of service and (2) file with BCBSNM within 180 days from the date of the primary explanation of benefits; the primary carrier EOB must be attached or its information entered in Availity Essentials. If there is no primary carrier and there is no documentation that the claim was sent to the wrong carrier within 180 days of the date of service, claims submitted after 180 days will be denied. Indian/tribal/urban providers have up to 2 years from the date of service to file claims.

This policy section is included for completeness.

Billing and coding

Medically Tailored Meals and Grocery Box HCPCSHCPCSCovered

S5170	Home delivered meals, including preparation; per meal
S5170 (modifier U1)	Weekly grocery box — One unit quantity of groceries sufficient for one week of meals. No more than 14 meals.

Diagnosis codes requiredICD-10Covered

ICD-10 (diabetes)	Diagnosis code reflecting diabetes (type 1, type 2, or gestational) required on claims
ICD-10 (pregnancy)	Diagnosis code reflecting pregnancy — should appear in one of the first five positions

Other billing codes referencedmixed

CPT	Current Procedural Terminology procedure codes (as applicable)
NDC	NDC codes in accordance with Medicaid requirements (if applicable)

Required visit and billing codesmixed

ICD-10	ICD-10 diagnosis codes (as indicated on visit)
CPT	Current Procedural Terminology procedure codes
NDC	National Drug Codes in accordance with Medicaid requirements
Place of service code	Place of service code for the service location

Meal units

Unit limitUp to 2 meals per day or grocery-box nutritional equivalent

Grocery-box unit definitionOne unit equals one week of meals (weekly grocery box) — no more than 14 meals per unit

Maximum durationCovered for up to 11 months and not to extend beyond two months postpartum

Provider responsibilities and billing requirements

Prior Authorization

Prior authorization — Prior authorization is not required

Prior authorization is not required for Food Is Medicine services. Providers must be able to receive referrals from Turquoise Care MCOs.

Prior authorization NOT required for covered Food Is Medicine services.
Providers must be able to receive referrals from Turquoise Care MCOs.

Prior Authorization

Preauthorization requirement — Include preauthorization number on claim when required

Preauthorization numbers must be included on the claim when a preauthorization was required for the service.

Include preauthorization number on claim if preauthorization was required.

Program background

Food Is Medicine provides home‑delivered medically tailored meals or medically tailored grocery boxes designed by a registered dietitian nutritionist (RDN) to meet the nutritional requirements of pregnant members with diabetes. Meals are individualized by an RDN in consultation with the member and must account for cultural, religious, and personal preferences. Coverage supports up to two meals per day (or a grocery‑box nutritional equivalent) for eligible members, subject to the policy’s quantity and duration limits.

Key definitions

Medically tailored meals

DefinitionFully prepared, home-delivered meals designed by a registered dietitian nutritionist to meet the unique nutritional requirements of pregnant members with diabetes

Meal planning requirementIndividualized meal plans must be designed by an RDN in consultation with the member and account for cultural, religious, and personal preferences

Program intentBenefit aims to support healthy birth outcomes for pregnant Medicaid recipients with type 1, type 2, or gestational diabetes

Medically tailored grocery boxes

DefinitionDistributions of unprepared or lightly processed food designed by a registered dietitian nutritionist for members to prepare at home; includes fresh produce, whole grains, legumes and lean proteins

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