Content
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.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: 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.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: 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 .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, 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.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 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 dietThis 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.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. HMSA's Medical Nutrition Therapy policy.
Change History
Rev#: Date: Nature of Change: 2.0 08/26/2025 1100-1205549-1492950 Updated: Healthy Diet for hyperlipidemia to Healthy Diet for cardiovascular risk factors. 1.4 (v6) 12/19/2024 1100-956557-1202268 The following updates were made to the Ketogenic Diet - Applicable Codes: 1.3 (v5) 11/20/2024 1100-956552-1182214 Updated the applicable codes for Dietetic treatment of eating disorders: 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 1.2 (v4) 09/18/2023 Removed code E88.81. Added codes: E88.810, E88.811, E88.818, and E88.819. 1.1 (v3) 05/11/2023 Fixed broken links. 1.0 (v2) 04/20/2021 Code and link updates. 0.0 (v1) 12/29/2020 First published.
