CurrentmhnPolicy N/A

Authorization Guide for Medically Tailored Meals/Medically Supportive Food

Defines authorization criteria, documentation requirements, service limits, eligible conditions, allowable providers, billing codes, and extension processes for medically tailored meals (MTM) or medically supportive food (MSF) delivered or grocery box programs for members with nutrition-sensitive chronic or serious health conditions.

Policy Summary

Payermhn

PolicyAuthorization Guide for Medically Tailored Meals/Medically Supportive Food

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit a CS Referral Form including the nutrition assessment and provider order specifying the nutrition-sensitive condition with the authorization request.

POLICY UPDATE CHANGES

No material clinical or coverage changes.

2Max meals per day

12 weeksInitial authorization duration

26 weeksTypical max program duration

>=2/3Nutrient coverage requirement

Coverage Summary

Scope: Defines authorization criteria, documentation requirements, service limits, eligible conditions, allowable providers, billing codes, and extension processes for Medically Tailored Meals (MTM) or Medically Supportive Food (MSF) delivered meals or grocery box programs for members with nutrition-sensitive chronic or serious health conditions. Coverage stance: covered_with_criteria. Eligible members: those with chronic or other serious health conditions that are nutrition-sensitive (examples include but are not limited to cancer, cardiovascular disorders, chronic kidney disease, chronic lung disorders such as asthma/COPD, chronic or disabling mental/behavioral health disorders, diabetes or other metabolic conditions, dyslipidemia, elevated lead levels, end-stage renal disease, fatty liver, gastrointestinal disorders, heart failure, high cholesterol, high‑risk perinatal conditions, HIV, hypertension, liver disease, malnutrition, and obesity).

Policy quick facts / thresholds

Max meals per day2

Initial authorization duration12 weeks

Typical max program duration with extension26 weeks (up to 14 additional weeks)

Nutrient coverage requirementMust meet at least two-thirds (>= 2/3) of daily nutrient and energy needs

Unit of servicePer delivered meal / per weekly grocery box delivered / per nutritional assessment

One meal type at a timeMember may receive either prepared meals or a grocery box, not both (change requires new auth)

Provider Actions & Documentation Requirements

Prior Authorization

Submit authorization request with documentation

Submit an authorization request (CS Referral Form) with required supporting documentation. Include the nutrition assessment and a provider order specifying the nutrition-sensitive condition when requesting authorization for services billed with the listed codes.

Affected codes: S5170, S9470, S9977
Required with authorization request: CS Referral Form, nutrition assessment, provider order specifying the nutrition-sensitive condition

Documentation Required

Nutrition assessment requirement

A nutrition assessment completed by a registered dietitian or other appropriate clinician must be submitted prior to meal request. The assessment must assess the member's nutrition-sensitive health condition and nutritional needs and include the meal plan and standards.

Documentation Required

Provider order requirement

A provider order from a licensed health care provider or other appropriate clinician (e.g., physician, RD, CNS, NP, pharmacist, PA) specifying the member's nutrition-sensitive condition must be submitted with the authorization request.

Prior Authorization

Change of meal type requires new authorization

If a member changes their meal type (prepared meal vs grocery box), a new authorization request is required.

Affected codes: S5170, S9977

Prior Authorization

Extensions require new documentation

Authorization extensions require submission of a new authorization request with an updated nutritional assessment and provider order. Typical extensions allow up to 14 additional weeks (total up to 26 weeks); extensions beyond 26 weeks require supporting clinical documentation (e.g., medical notes) demonstrating ongoing medical and/or nutritional need.

Background & Definitions

Background: Medically Tailored Meals (MTM) and Medically Supportive Food (MSF) programs provide prepared meals or grocery boxes plus nutrition education and behavioral supports to address nutrition-sensitive chronic or serious conditions with the intent to improve health outcomes and reduce unnecessary medical costs. MTM/MTG meals or groceries must meet at least two-thirds of the daily nutrient and energy needs of an average individual as estimated by the registered dietitian nutritionist (RDN) or clinician overseeing the service. MSF are supplemental, intended as a step-down intervention when appropriate, and MSF services must be overseen and signed off on by an RDN or another appropriate clinician. Services are overseen by an RDN or other appropriate clinician and require a nutrition assessment (including the meal plan and standards) and a provider order to be submitted with the authorization request. Covered billing codes include S5170 (home delivered prepared meal), S9977 (per weekly grocery box, delivered), and nutritional counseling S9470.

Term	Definition
Medically tailored meals (MTM) / Medically tailored groceries (MTG)
Meals or groceries designed to meet at least two-thirds of the daily nutrient and energy needs of an average individual as estimated by the RDN/clinician overseeing design; delivered as part of clinical care to address a member's nutrition-sensitive health condition and not intended solely to respond to food insecurity.
Medically supportive foods (MSF)
Supplemental food packages that adhere to national nutrition guidelines to prevent, manage, or reverse nutrition-sensitive conditions; intended as a step-down intervention from medically tailored foods where appropriate and must be overseen/signed off by an RDN or other appropriate clinician.
Allowable providers
Includes area agencies on aging; home delivered meal providers; produce prescription services and other MSF and nutrition providers; MTM providers; medically tailored or supportive grocery providers (e.g., food banks); nutrition education providers; and nutrition services providers serving pregnant/postpartum individuals.

Policy Summary

Payermhn

PolicyAuthorization Guide for Medically Tailored Meals/Medically Supportive Food

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit a CS Referral Form including the nutrition assessment and provider order specifying the nutrition-sensitive condition with the authorization request.

On This Page

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Authorization Guide for Medically Tailored Meals/Medically Supportive Food

Coverage Summary

Medical Necessity & Authorization Criteria

Billing Codes

Provider Actions & Documentation Requirements

Background & Definitions

Revision History

S5170	home delivered prepared meal
S9470	nutritional counseling, diet
S9977	per weekly grocery box, delivered