CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy | Nutritional Counseling/Medical Nutritional Therapy

Defines claims filing, coverage stance, and billing codes for nutritional counseling/medical nutritional therapy for Blue Cross Blue Shield - Rhode Island members, applicable to Medicare Advantage and commercial products and providers (registered dietician/nutritionist).

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPayment Policy | Nutritional Counseling/Medical Nutritional Therapy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateFeb 19, 2008

Next Review DateApr 1, 2026

Key ActionFile claims using CPT 97802, 97803, or 97804 when services are provided by a Registered Dietician/Nutritionist.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

97802–97804Covered CPT codes

Not requiredPrior authorization

See EOCBenefits vary

Certain S/G codesCodes that will deny

MedicareAdv & CommercialApplies to

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Coverage Criteria

Coverage for Medicare Advantage and Commercial Products

Coverage for nutritional counseling/medical nutritional therapy (MNT) under Medicare Advantage and commercial products.

Nutritional counseling/medical nutritional therapy is a covered service when provided by a Registered Dietician/ Nutritionist.

Benefits may vary by group/contract; refer to the Evidence of Coverage or Subscriber Agreement for applicable nutritional counseling benefits.

Claims must be filed using CPT codes 97802, 97803, or 97804 when services are provided by a Registered Dietician/Nutritionist.

Do not bill using codes S9452, S9470, G0270, or G0271; claims submitted with these codes will deny and must be replaced with the CPT codes specified in this policy.

Prior authorization review is not required for these services.

Billing and Codes

Covered CPT codes (when provided by Registered Dietician/Nutritionist)CPTCovered

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 (two or more individuals), each 30 minutes

Codes that will denymixedNot Covered

S9452	Nutrition classes, non-physician provider, per session
S9470	Nutritional counseling, dietitian visit
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 patient, each 15 minutes
G0271	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), group (two or more individuals), each 30 minutes

Provider Actions & Requirements

Prior Authorization

No prior authorization required

Prior authorization review is not required.

Definitions and Provider Qualifications

Specialized nutrition therapies — definition and examples (medical foods, supplementation)

DefinitionSpecialized nutrition therapies include supplementation with medical foods for those unable to obtain adequate nutrients through food intake only; enteral nutrition via tube feeding into the gastrointestinal tract; and parenteral nutrition via intravenous infusion.

PurposeUsed to treat an illness or condition or to improve health outcomes when standard dietary intake is insufficient.

ExamplesMedical foods (supplementation), enteral nutrition (tube feeding), parenteral nutrition (intravenous infusion).

Provider requirement — covered when provided by a registered dietician/nutritionist

Coverage requirementNutritional counseling/medical nutritional therapy is a covered service when provided by a registered dietician/nutritionist.

Applicable plans