Insurance coverage · Coverage
Medi-Cal nutrition counseling
By Javier Alvarez · Updated · 5 min read
| Governing manual | Medi-Cal Provider Manual, Part 2, Medicine: Nutrition Counseling (updated October 2025) |
|---|---|
| Codes | 97802, 97803 (15-min units), 97804 (30-min units) |
| Fee-for-service limit | 3 hours the first calendar year, 2 hours each later calendar year; more with a TAR |
| Same-day conflict | 97802–97804 can't be billed on the same date as DSMT G0108/G0109 |
| Managed care | Plan-specific: e.g. Partnership HealthPlan pays up to 12 hours of 97803 per rolling 12 months without a TAR |
| Children with CCS conditions | MNT by a CCS-paneled dietitian, authorized through the CCS program |
| Z5802 | Retired local CCS code from 2005; current CCS lists use 97802–97804 |
| Telehealth | Modifier 95 (video), 93 (audio-only); POS 02 or 10 |
| Last verified | September 28, 2026 |
The short answer
Medi-Cal, California's Medicaid program, has a written medical nutrition therapy benefit. The Medi-Cal provider manual's Nutrition Counseling section (updated October 2025) lists 97802, 97803 and 97804 and limits MNT to three hours in the first calendar year and two hours per calendar year after that. Additional hours need a Treatment Authorization Request (TAR), or for children in California Children's Services (CCS), a CCS Service Authorization Request (SAR).
That's the fee-for-service baseline. Most Medi-Cal members are enrolled in a managed care plan, and each plan publishes its own MNT policy. Two plans' policies, quoted below, differ more than the state manual and either plan: one pays up to 12 hours of follow-up a year with no authorization, the other requires prior authorization for every visit and keeps the 3-and-2-hour limit.
Who can bill Medi-Cal for nutrition counseling
This is where California differs from states like New York, which enrolls dietitians as their own Medicaid provider type.
- Fee-for-service enrollment. DHCS publishes a list of provider types that have a fee-for-service enrollment pathway in its APL 22-013 FAQ. We didn't find registered dietitians on it. The same FAQ says managed care plans don't have to enroll provider types that have no fee-for-service pathway.
- Managed care contracts. Plans credential and contract with dietitians themselves. Partnership HealthPlan of California's policy says MNT must be provided by an RD/RDN or a Certified Diabetes Care and Education Specialist, working either for a contracted provider (primary care, specialist, hospital, home health, hospice) or contracted individually with the plan, with the credential on file for claims to pay.
- Through an enrolled group. Dietitians employed by an enrolled clinic, hospital or medical group bill under that organization's arrangements.
Confirm the path with each plan's provider relations team before you see members. Our guide to insurance credentialing covers the paperwork most plans ask for.
Fee-for-service rules (the state manual)
| Rule | What the manual says |
|---|---|
| Codes | 97802 initial, 97803 re-assessment (each 15 minutes); 97804 group (each 30 minutes) |
| Frequency | 3 hours in the first calendar year; 2 hours per calendar year after that |
| More hours | Bill with a TAR, CCS/GHPP stamp or CCS SAR |
| DSMT conflict | 97802–97804 can't be billed on the same date of service as G0108 or G0109 |
| DSMT limits | G0108: 1 hour individual; G0109: up to 9 hours group, in the first 12 months; 2 hours combined per calendar year after |
Units still follow the CPT time rules. If the minutes-to-units math is where your claims go wrong, see CPT 97803 and the 8-minute rule for dietitians.
Managed care plans: two real policies
Medi-Cal plans cover MNT, but their limits and authorization rules are their own. Two published examples:
Partnership HealthPlan of California (MCUP3052, last reviewed September 9, 2026). For qualifying diagnoses listed in its attachment, no TAR and no Referral Authorization Form are needed within these limits, counted in CPT units per rolling 12 months:
- 97802: up to 12 units (3 hours); one initial visit per date of service per qualifying diagnosis
- 97803: up to 48 units (12 hours)
- 97804: up to 72 units (36 hours), after an individual visit, and no more than 2 hours per date of service
- 98970–98972: virtual meal-plan journal review for qualifying eating disorder diagnoses, up to 72 units
- A TAR is required past these limits. Referring providers note the diagnosis MNT is for.
Central California Alliance for Health (MNT quick reference). MNT by a registered dietitian is covered for members with qualifying conditions, but prior authorization is required, and coverage is capped at 3 hours in the first calendar year and 2 hours per calendar year after. Its code list includes 97802–97804, G0270, G0271 and S9470.
Same state, same codes, very different rules. Read the member's plan policy, not just the state manual.
Children: California Children's Services and the Z5802 question
For children whose condition is eligible for California Children's Services (CCS), MNT is provided by a CCS-paneled (approved) registered dietitian and authorized through the CCS program.
Search for Medi-Cal dietitian codes and you'll find Z5802. It comes from CCS Numbered Letter 16-0605, dated June 13, 2005, which told county CCS programs to authorize MNT by a CCS-approved dietitian under HCPCS code Z5802 (dietitian services). That letter is two decades old. The current CCS Service Code Groupings list 97802, 97803 and 97804 with an effective date of April 1, 2016, and Z5802 doesn't appear. Bill the CPT codes your SAR authorizes, and ask the county CCS office if an old authorization still names Z5802.
For children not in CCS, federal EPSDT rules still require coverage of medically necessary services; see our Medicaid overview.
Telehealth
Medi-Cal's Telehealth Modalities section (updated November 2025) sets these rules for covered services:
- Modifier 95 for synchronous audio-video; modifier 93 for audio-only; GQ for store-and-forward.
- POS 02 for telehealth outside the member's home; POS 10 for telehealth in the home.
- The provider must be licensed in California and enrolled as a Medi-Cal rendering provider or affiliated with an enrolled Medi-Cal group physically located in California.
Plans can publish their own telehealth policies (Partnership's MNT policy points to its separate telehealth policy). More on the modifier and POS pairing in telehealth billing for dietitians.
How to verify a Medi-Cal member's benefits
- Eligibility and plan. Confirm Medi-Cal eligibility and which managed care plan the member is in (or fee-for-service). See 270/271 eligibility checks.
- Your network status with that plan. Out-of-network visits to a managed care member usually aren't paid.
- The plan's MNT policy: qualifying diagnoses, hour or unit limits, whether prior authorization or a referral is needed.
- Hours used this calendar year or rolling 12 months, across providers.
- CCS: if the child has a CCS-eligible condition, get the SAR before billing.
- Record the representative's name, date and reference number. Our verification call script has the wording.
For dietitians: claim tips
- Get credentialed with the plans your patients have before scheduling them.
- Don't bill DSMT (G0108/G0109) and MNT on the same date of service.
- Track hours against the plan's period: calendar year for the state manual, rolling 12 months for plans like Partnership.
- Request authorization early. See prior authorization for nutrition services.
- Drop Z5802 from any old templates unless an authorization tells you otherwise.
Not legal or billing advice. DHCS and each Medi-Cal plan update their policies; check the current manual and the member's plan before billing.