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HealthPartners

Coverage criteria policies

Nutrition (medical) therapy - Minnesota Health Care Programs

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for medical nutrition therapy.

Coverage

Nutrition Therapy is generally covered when provided by a HealthPartners’s licensed dietician or licensed nutritionist and prescribed/referred by a physician. This includes medical nutrition therapy (MCT), diabetic outpatient self-management (DSMT) and MNT for weight management.

Indications that are covered

  1. Evaluation
  2. Follow-up
  3. Group counseling prescribed by a physician

Indications that are not covered

  1. Weight loss services on a program basis
  2. Nutritional supplements or foods for the purpose of weight reduction
  3. Exercise classes
  4. Health club memberships
  5. Instructional materials and books
  6. Motivational classes
  7. Counseling or weight loss services provided by non-HealthPartners providers
  8. Counseling that is part of the physician's covered services and for which payment has already been made
  9. Nutritional counseling for diabetic education when it is part of a diabetic education program (see Diabetic Education section)

Definitions

Counseling to assess and minimize the problems hindering normal nutrition and to improve a member's nutritional status. Nutritional counseling may be provided in a physician's office, clinic, or outpatient hospital setting.

If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

97802

Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with

the patient, each 15 minutes

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

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

Portions of the contents of these coverage criteria relating to Minnesota Public Programs medical coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual at http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_
CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_008926#P1052_82075

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Policy activity

  • 10/31/1994 - Date of origin
  • 05/01/2017 - Effective date
Review date
  • 05/2017

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