| Service | Code | Description | Applicable Codes |
|---|---|---|---|
|
*Dietetic treatment of eating disorders. Refer to HMSA’s Dietetic Treatment for Eating Disorders policy. |
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face to face with the patient, each 15 minutes | F50.00, F50.010, F50.011, F50.012, F50.013, F50.014, F50.019, F50.020, F50.021, F50.022, F50.023, F50.024, F50.029, F50.20, F50.21, F50.22, F50.23, F50.24, F50.25, F50.810, F50.811, F50.812, F50.813, F50.814, F50.819, F50.82, F50.89, F50.9 |
| 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 | ||
| S9470 | Nutritional counseling, dietitian visit | ||
|
*Obesity. Refer to Preventive Health Guidelines for Newborns and Children, Men, and Women. |
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face to face with the patient, each 15 minutes |
Primary Dx: Z04.6, Z13.1 E66.01-E66.1 E66.8-E66.9. |
| 97803 | Medical nutrition therapy; re-assessment and intervention, individual, face to face with the patient each 15 minutes | ||
| 97804 | group (2 or more individual(s)) each 30 minutes | ||
| S9470 | Nutritional counseling, dietitian visit | ||
|
Healthy Diet for cardiovascular risk factors. Refer to Preventive Health Guidelines for Newborns and Children, Men, and Women. |
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
Z71.3 with one of these additional diagnoses: E10.10-E10.9, E11.00-E11.9, E13.00-E13.9, E66.01, E66.09, E66.3, E75.6, E78.00, E78.70, E78.1, E78.2, E78.79, E78.89, E78.9, E88.810, E88.811, E88.818, E88.819, E88.89, I10, I11.0, I11.9, R73.01-R73.03, R73.09, R73.9 |
| 97803 | re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97804 | group (2 or more individual(s)) each 30 minutes | ||
| S9452 | Nutrition classes, nonphysician provider, per session | ||
| S9470 | Nutritional counseling, dietitian visit | ||
|
Patient has been diagnosed with certain inborn errors of metabolism. See HMSA’s Medical Foods for inborn Errors of Metabolism. This service is limited to 4 visits per calendar year. Please refer to the MNT policy for more information. |
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
E70.0 – E70.9, E71.0-E71.39, E72.00-E72.9 |
| 97803 | re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97804 | group (2 or more individual(s)) each 30 minutes | ||
|
Swallowing impairment or malnutrition due to head or neck cancer (e.g. Oral surgery related to head or neck cancer). This service is limited to 4 visits per calendar year. Please refer to the MNT policy for more information. |
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
E43, E44.0, E44.1, E46, R13.10 with one of these additional diagnoses: C02.0, C08.0, C10.0, C32.0-C32.9 D10.6. |
| 97803 | re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97804 | group (2 or more individual(s)) each 30 minutes | ||
|
Ketogenetic diet This service is limited to eight (8) visits in the first 24 months and four (4) visits each year thereafter. |
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | E74.4, E88.09, G40.001, G40.011, G40.019, G40.101, G40.111, G40.201, G40.211, G40.301, G40.311, G40.A01, G40.A11, G40.B01, G40.B11, G40.401, G40.411, G40.419, G40.501, G40.801, G40.803, G40.804, G40.811, G40.813, G40.821, G40.823, G40.823, G40.841, G40.842, G40.843, G40.844, G40.901, G40.911. G93.45 |
| 97803 | re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97804 | group (2 or more individual(s)) each 30 minutes | ||
|
Chronic kidney disease (CKD) with a glomerular filtration rate (GFR) less than 45, i.e., non-dialysis G3b, G4, and G5. This service is limited to 4 visits per calendar year. Please refer to the MNT policy for more information. |
97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | N18.30, N18.31, N18.32, N18.4, N18.5. |
| 97803 | re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97804 | group (2 or more individual(s)) each 30 minutes | ||
| Codes that do not meet payment determination criteria. MNT billed for these services will be denied not medically necessary. Please see the MNT policy for more information. | 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | F51.0 - F99, G20-G21.2, G30.0, S38.1xxA, S38.1xxD, S38.1xxS. |
| 97803 | re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97804 | group (2 or more individual(s)) each 30 minutes |
*Precertification is required. Please refer to the HMSA medical policy.
For more information, please refer to HMSA’s Medical Nutrition Therapy policy.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |