Insurance coverage · Coverage

Georgia Medicaid nutrition counseling

By Javier Alvarez · Updated September 29, 2026 · 4 min read

The short answer

Georgia Medicaid has a dietitian benefit, but it lives in a children's program. The Department of Community Health's Part II Policies and Procedures for Children's Intervention Services (CIS, version dated July 1, 2026) lists seven services, one of which is "nutrition provided by licensed dietitians."

CIS serves Medicaid members from birth to age 21 with physical disabilities or a developmental delay, when their primary care practitioner prescribes the services. Dietitians enroll as individual providers and bill 97802, 97803 and 97804 with the HA modifier.

For adults, we didn't find a dietitian MNT benefit: the July 2026 Physician Services manual doesn't list 97802–97804 or dietitian services. Adults with Georgia Medicaid should ask their health plan about any extra benefits it offers.

Who can bill

Section 601 of the CIS manual says providers must be currently licensed in Georgia, and lists licensed dietitians among the qualified provider types. Section 602 adds:

• Enroll as an individual provider and attach a copy of your license.
• In a group practice, hospital or agency, each provider enrolls separately and bills for the services they personally provide under their own provider number. Services by non-enrolled providers in a group aren't covered.
• Pediatric continuing education: keep on file proof that at least one-third of your licensing board's required CEUs are in pediatrics (section 603.10).

Our credentialing guide covers the general sequence of state enrollment, then health plan contracts.

Who is covered

A child qualifies for CIS when the child is Medicaid-eligible, is under 21, has a physical disability or developmental delay, and falls into one of two groups (section 701):

1. Children with a Letter of Medical Necessity (LMN) or Plan of Care (POC) established or approved by their primary care practitioner (PCP).
2. Infants and toddlers in Georgia's early intervention program (Babies Can't Wait) with an authorized Individualized Family Service Plan (IFSP). They still need the POC/LMN too.

The POC signed by the PCP counts as the PCP's letter of medical necessity, and the two can be combined into one document. Nutrition services, per section 902.7, include nutritional history, dietary intake, anthropometrics, lab evaluation and feeding behavior. For the referral side, see physician referrals for dietitians.

Children also have federal EPSDT protection for medically necessary services; our Medicaid overview explains how that works across states.

Codes, limits and rates

The CIS manual's nutrition services table (section 1001.2):

Program rules that apply on top:

• 1 unit equals a minimum of 15 minutes unless otherwise specified. That CIS rule is stricter than the CPT midpoint convention most payers use; see the 8-minute rule for dietitians for how the two differ.
• Eight units per month, per specialty. After the eighth unit in a month, further claims deny unless the units were prior authorized.
• The child's PCP NPI is required on all claims.
• NCCI edits and medically unlikely edits apply.

Code details: CPT 97802 and CPT 97804 for groups.

Prior authorization

• Not required for evaluation services (section 802.1.4).
• Required for units past the monthly limit. The request counts the eight units you already have: if a child needs 12 units a month, you ask for the extra 4.
• Good for up to 180 calendar days, and granted only for documented medically necessary services.
• Modifiers on the PA and the claim must match. If the POC/LMN dates and the PA dates differ, the POC/LMN dates control.

More on building a request that gets approved: prior authorization for nutrition services.

Telehealth

The CIS manual still carries a provision from April 2020 letting therapy services be rendered by telehealth, with the usual program modifiers and place of service 02. Georgia's separate Telehealth Guidance manual (July 2026) says to bill the professional code with the GT modifier as applicable and/or POS 02 or POS 10 (the patient's home). The two documents don't line up perfectly, so confirm the combination DCH or the member's plan expects before billing telehealth nutrition visits. General guidance: telehealth billing for dietitians.

Managed care

Many Georgia Medicaid children are enrolled in a Georgia Families care management organization (CMO). The CIS manual points to Georgia Families program documents but doesn't spell out, for nutrition, whether claims go to DCH or the CMO. Ask the member's CMO whether it pays CIS nutrition services, whether you must be in its network, and what authorization it requires.

How to verify a Georgia Medicaid child's benefits

1. Eligibility and plan: fee-for-service or a CMO, and which one. See 270/271 eligibility checks.
2. CIS eligibility: under 21 with a physical disability or developmental delay.
3. Paperwork: the PCP's LMN or signed POC (plus IFSP for Babies Can't Wait), and the PCP's NPI.
4. Units this month across nutrition providers, and visits used this year.
5. Record the rep's name, date and reference number (verification call script).

For dietitians: claim tips

• Append HA (and TS on 97803) exactly as the manual lists them.
• Put the PCP's NPI on every claim.
• Track the monthly 8-unit cap before scheduling extra visits, and request PA in time.
• Keep your pediatric CEUs documented for audits.

Not legal or billing advice. DCH updates its Part II manuals quarterly; check the current CIS and telehealth manuals and the member's CMO before billing.