Name of Manual - Blue Cross and Blue Shield of Minnesota

Nutritional
Counseling/Medical
Nutrition Therapy
Services
97802-97804, S9470
Coding Policies and Guidelines (Behavioral Health)
Medical nutrition therapy services are usually eligible if billed
with either a behavioral health diagnosis or with a disease related
diagnosis such as obesity or diabetes. Group nutritional therapy
services billed under code 97804 are generally only covered when
submitted with diagnosis codes for anorexia, bulimia, diabetes,
congestive heart failure, and some maternity diagnoses. Obesity is
not an eligible diagnosis for code 97804.
There are no limits to the number of eligible services a patient
receives if the patient has a fully insured contract. In contrast,
some self-insured contracts may choose to apply contract
variations/exclusions for nutritional counseling/medical nutrition
therapy services.
The contract for Federal Employee Program members (who have
ID numbers beginning with “R”) only allows medical nutrition
therapy services in the following situations: Dietitian assessments
as part of a multi-disciplinary eating disorder evaluation; and
medical nutrition therapy services as part of ongoing nutritional
therapy for eating disorders anorexia nervosa (diagnosis code
307.1) and/or bulimia nervosa (diagnosis code 307.51.) Coverage
is extended to diabetic educators, dietitians, and nutritionists who
bill independently as part of a covered diabetic education program
only. Nutritional counseling for up to four visits per year is
covered when billed by a covered provider, although nutritional
counseling for the treatment of anorexia and/or bulimia billed with
diagnosis codes 307.1 or 307.51 is not subject to the four visit
limitation.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-29