Resources
Resources
CODING & DOCUMENTATION
EDUCATION & EVENTS
ENROLLMENT & CREDENTIALING
FORMS & MANUALS
HEALTHCARE INFORMATION & TECHNOLOGY
PATIENT HEALTH
PHARMACY
POLICIES & GUIDELINES
PRE-SERVICE REVIEW
PROGRAMS & INITIATIVES
PROVIDER NETWORKS & SPECIALTIES
Medical Nutrition Therapy Services
Expanded Dietitian Coverage 2021
For dates of service January 1, 2021, and after, additional benefits are available for medical nutrition therapy services:
- With the implementation of a Participating Dietitian Network on January 1, 2021, medical nutrition therapy can now be billed by an in-network dietitian. Preferred medical doctors are also able to continue billing for these services. Services performed by a physician will be reimbursed.
- Licensed registered dietitians must be credentialed by Blue Cross and Blue Shield of Alabama to participate in this network. Once in the network they will be able to file claims for services provided to Blue Cross and Blue Shield of Alabama members.
- Eating disorders are a behavioral health diagnosis and not covered under medical nutrition therapy. Only the symptoms of an eating disorder (e.g. obesity) would be covered, but an actual condition (bulimia) would not be covered. Please code the medical diagnosis.
Always check eligibility and benefits to verify a patient has coverage. Some groups may not have this new benefit.
Conditions/Diagnosis Codes
The following CPT codes are billable in any combination for up to six hours. These codes can be billed in addition to the existing three hours of dietitian benefits already covered through the Affordable Care Act (ACA). Only healthcare reform compliant groups will cover these three hours. The additional six hours that will be available with the expansion of Medical Nutrition Therapy services is separate from the three hours of benefits that is already available today for some groups through healthcare reform.
Always check eligibility and benefits to verify coverage of these services.
| CPT/HCPCS Code | Description | Frequency Per Calendar Year |
| 97802 | Medical Nutrition Therapy; initial assessment and intervention, individual, face-to-face with patient, each 15 minutes |
For ACA-compliant plans, 3 hours per calendar year with no cost share (age 18+ only) For plans with expanded benefit, 6 hours per calendar year with cost share applied (no age restrictions) – 3 hours covered with limited set of diagnoses matching ACA benefit and 3 hours covered with expanded list of diagnosis codes |
| 97803 | Medical Nutrition Therapy; re-assessment and intervention, individual, face-to-face with patient, each 15 minutes |
For ACA-compliant plans, 3 hours per calendar year with no cost share (age 18+ only) For plans with expanded benefit, 6 hours per calendar year with cost share applied (no age restrictions) – 3 hours covered with limited set of diagnoses matching ACA benefit and 3 hours covered with expanded list of diagnosis codes |
| 97804 | Medical Nutrition Therapy; group (2 or more individuals), each 30 minutes |
For ACA-compliant plans, 3 hours per calendar year with no cost share (age 18+ only) For plans with expanded benefit, 6 hours per calendar year with cost share applied (no age restrictions) – 3 hours covered with limited set of diagnoses matching ACA benefit and 3 hours covered with expanded list of diagnosis codes |
| G0270 | Medical Nutrition Therapy; re-assessment and subsequent interventions 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 |
For ACA-compliant plans, 3 hours per calendar year with no cost share (age 18+ only) For plans with expanded benefit, 6 hours per calendar year with cost share applied (no age restrictions) – 3 hours covered with limited set of diagnoses matching ACA benefit and 3 hours covered with expanded list of diagnosis codes |
| G0271 | Medical Nutrition Therapy; re-assessment and subsequent interventions following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes |
For ACA-compliant plans, 3 hours per calendar year with no cost share (age 18+ only) For plans with expanded benefit, 6 hours per calendar year with cost share applied (no age restrictions) – 3 hours covered with limited set of diagnoses matching ACA benefit and 3 hours covered with expanded list of diagnosis codes |
| G0446 | Annual face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes |
For ACA-compliant plans, 3 hours per calendar year with no cost share (age 18+ only) For plans with expanded benefit, 3 hours per calendar year with cost share applied (no age restrictions) – covers only limited set of diagnoses matching ACA benefit |
| G0447 | Individual, face-to-face counseling for obesity, 15 minutes |
For ACA-compliant plans, 3 hours per calendar year with no cost share (age 18+ only) For plans with expanded benefit, 3 hours per calendar year with cost share applied (no age restrictions) – covers only limited set of diagnoses matching ACA benefit |
The Medical Nutrition Therapy Services outlined above are separate benefits from what are allowed for healthcare reform. For dates of service January 1, 2020, and after, participating in-network dietitians will be allowed to bill for the CPT codes allowable under healthcare reform with specific ICD-10 diagnosis codes. Expanded benefits will be available January 1, 2021.
Certain groups cover three hours of dietitian services under the Affordable Care Act (ACA); however, some plans that are not ACA compliant do not cover these hours. This can result in the following scenarios:
- Patients with 9 total hours of benefits - 3 hours under the ACA with no cost share, 6 with cost sharing
- Patients with 6 total hours of benefits - all with cost sharing applied
- Patients with 3 total hours - 3 hours under the ACA with no cost share and no expanded benefits*
The ACA does not cover Medical Nutrition Therapy services for members under age 18. Groups that are ACA compliant and have the expanded benefits will allow for nine total hours for their members 18 and above, but will allow just six total hours for members under 18.