Insurance coverage · Coverage
MassHealth nutrition counseling
By Javier Alvarez · Updated · 4 min read
| Governing rules | 130 CMR 405.475 (community health centers); Physician Bulletin 86 (2007); CHC and Physician Subchapter 6 |
|---|---|
| What's covered | Nutritional diagnostic therapy and counseling to manage a medical condition |
| Codes | 97802, 97803, 97804, G0270, G0271; DSMT G0108/G0109 for prediabetes or diabetes |
| Who bills | CHCs, physicians, hospital outpatient departments; independently enrolled NPs and nurse-midwives |
| Dietitian as its own provider type | Not found in MassHealth's provider manual list |
| Telehealth | Allowed for covered services (All Provider Bulletin 379); POS 02 or 10, modifiers 95, 93 or GQ |
| Last verified | September 28, 2026 |
The short answer
MassHealth, Massachusetts' Medicaid and CHIP program, pays for medical nutrition therapy. The community health center regulation, 130 CMR 405.475, says MassHealth "pays for nutritional diagnostic therapy and counseling services for the purpose of management of a medical condition," and the codes are the standard MNT set: 97802, 97803, 97804, G0270 and G0271.
What makes MassHealth different from states like New York or Washington is who sends the claim. MassHealth's rules pay MNT through community health centers (CHCs), physicians, hospital outpatient departments and certain independently enrolled practitioners. We found no dietitian provider type: there's no dietitian or nutritionist manual in MassHealth's list of provider manuals, and no bulletin creating one. That's our reading of what MassHealth publishes, not a statement MassHealth makes, so confirm with provider enrollment.
Who can provide and who can bill
Community health centers. Under 130 CMR 405.475(B), MNT is payable when provided by:
- Physicians
- Dietitians/nutritionists licensed by the Massachusetts Division of Professional Licensure and the Board of Registration of Dietitians and Nutritionists
- Mid-level practitioners credentialed by the Commission on Dietetic Registration (such as nurse midwives, nurse practitioners, registered nurses and physician assistants)
- Other providers licensed by that board with the nutrition counseling training described in the Medicare statute
The CHC bills; the licensed dietitian is the practitioner.
Physician practices. Physician Bulletin 86 (July 2007) made MNT and DSMT payable for dates of service from July 1, 2007. It says MNT and DSMT are payable to a physician when provided by mid-level practitioners under the physician's supervision, and payable to nurse-midwives and nurse practitioners enrolled independently. It also says physicians may bill an office visit and MNT codes on the same date.
Hospital outpatient departments bill under their own MassHealth rules.
If you're a dietitian in private practice, this usually means working for or contracting with one of those entities to see MassHealth members. Billing under someone else's number has its own rules; read can dietitians bill incident-to? before setting up that kind of arrangement.
Codes and limits
| Code | What it is | Where MassHealth lists it |
|---|---|---|
| 97802 | MNT initial assessment, 15-min units | CHC Subchapter 6; payable under the Physician Manual's general CPT rule |
| 97803 | MNT re-assessment, 15-min units | Same |
| 97804 | MNT group, 30-min units | Same |
| G0270, G0271 | MNT after a change in condition (individual, group) | CHC Subchapter 6; Physician Subchapter 6 payable HCPCS list |
| G0108, G0109 | Diabetes self-management training | Prediabetes or diabetes only |
The CHC Manual Subchapter 6 lists these codes without unit limits. The Physician Manual Subchapter 6 pays medicine CPT codes in effect at the time of service except those it lists as non-payable, and the MNT codes aren't on that exclusion list. MNT isn't limited to a diagnosis list in the regulation; DSMT is limited to members with prediabetes or diabetes.
For the codes themselves: CPT 97802, G0270 and G0271, G0108 and G0109.
Referral
Bulletin 86 said members in the PCC Plan didn't need a PCC referral for MNT or DSMT. That bulletin is from 2007. Most MassHealth members are now enrolled in accountable care organizations (ACOs) or managed care organizations, which set their own referral and authorization rules. Ask the member's plan. A written referral from the treating provider is still good practice for documenting medical necessity; see physician referrals for dietitians.
Telehealth
All Provider Bulletin 379 (October 2023) lets providers deliver any medically necessary covered service by live video, audio-only or asynchronous telehealth, except the categories it lists, and MNT isn't among them. Claims use POS 02 or POS 10 and the matching modifier: 95 for video, 93 for audio-only, GQ for asynchronous. More in telehealth billing for dietitians.
Managed care: ACOs and MCOs
Most MassHealth members get care through an ACO or managed care plan, and those plans credential their own networks. We didn't verify individual plans' MNT rules. Before seeing a member, ask the plan:
- Do you credential registered or licensed dietitians directly, or only through contracted groups?
- Are 97802 and 97803 covered for this member's diagnosis?
- Is a referral or prior authorization required, and how many units are allowed?
How to verify a MassHealth member's benefits
- Eligibility and plan: MassHealth coverage type (Standard, CommonHealth, Family Assistance and others) and the member's ACO or MCO. See 270/271 eligibility checks.
- Billing entity: confirm the CHC, practice or hospital you work through is enrolled and in the member's network.
- Codes and diagnosis: confirm 97802/97803 for the diagnosis you'll bill.
- Referral and authorization under the member's plan.
- Record the rep's name, date and reference number (verification call script).
Not legal or billing advice. MassHealth rules and plan policies change; check the current regulations, manuals and the member's plan before billing.