Insurance coverage · Coverage
Pennsylvania Medicaid nutrition counseling
By Javier Alvarez · Updated · 3 min read
| Governing bulletin | MA Bulletin 23-20-01 (and others), Childhood Nutrition and Weight Management Services, May 26, 2020 |
|---|---|
| Who can enroll | Provider Type 23 Nutritionist, specialty 230 (PA license + dietetic registration card) |
| Who is covered | MA beneficiaries under 21 with weight management problems |
| Code | S9470 with U3 TJ; 1 visit per day; no prior authorization |
| Fee (PT 23) | $26.46 per visit (MA Outpatient Fee Schedule) |
| Places of service | 11, 12, 99 in the bulletin; the online fee schedule also lists 02 and 10 |
| CPT 97802–97804 | Not found on the MA outpatient fee schedule |
| Last verified | September 28, 2026 |
The short answer
Pennsylvania's Medicaid program, Medical Assistance (MA), does enroll dietitians, but the fee-for-service benefit they can bill is narrow. It comes from the Childhood Nutrition and Weight Management Services (CNWMS) program, described in MA Bulletin 23-20-01 (issued and effective May 26, 2020, together with bulletins for physicians, CRNPs, clinics and FQHCs):
- Who: MA beneficiaries under 21 who are experiencing weight management problems.
- What a nutritionist bills: S9470, nutritional counseling, dietitian visit, with modifiers U3 and TJ, one visit per day.
- Prior authorization: none.
The medical nutrition therapy CPT codes most payers use (97802, 97803, 97804) didn't turn up on the MA outpatient fee schedule, and we found no adult dietitian benefit in fee-for-service.
Who can bill
Dietitians enroll as Provider Type 23 (Nutritionist), specialty 230, per DHS's enrollment requirements. You can enroll as an individual or a group. The individual application needs:
- The signed provider agreement and ownership or control interest disclosure
- A copy of your license from the Department of State (Pennsylvania's licensed dietitian-nutritionist, or LDN)
- A copy of your dietetic registration card
Provider Type 23 can also enroll for the Aging Waiver and Adult Autism Waiver programs, which are separate from CNWMS. Our credentialing guide covers the general order: state enrollment, then managed care contracts.
What's covered and how to bill it
The bulletin lets MA pay physicians, CRNPs, nutritionists, outpatient hospitals, clinics, FQHCs and RHCs for CNWMS "when the services are medically necessary and rendered to MA beneficiaries under 21 years of age who are experiencing weight management problems." For nutritionists, the fee schedule attached to the bulletin lists one line:
| Code | Provider type / specialty | Places of service | Modifiers | Unit | Limit | Prior auth |
|---|---|---|---|---|---|---|
| S9470 nutritional counseling, dietitian visit | 23 / 230 | 11, 12, 99 | U3, TJ | Encounter (per visit) | 1 visit per day | No |
The MA Outpatient Fee Schedule, checked September 28, 2026, shows $26.46 for Provider Type 23, specialty 230, S9470 with U3, ages 0 through 20, one unit, no prior authorization. It also lists places of service 02 and 10 (telehealth) for that line, which the 2020 bulletin predates. A search for 97802 returned no record.
Because S9470 is a per-visit code, the length of the session doesn't change the payment. That's the opposite of 97802/97803 time-based billing; see S9470 and CPT codes for dietitians for how the two approaches differ.
Documentation and medical necessity
- Document medical necessity in the child's record under 55 Pa. Code § 1101.51, as the bulletin requires.
- The Department encourages a recent EPSDT screening or physical exam to support medical necessity. It's not a formal referral requirement, but get a copy.
- Record the weight management problem you're treating, growth measures and the plan. Our charting for medical necessity guide shows what reviewers look for.
FQHCs and RHCs
For children under 21, MA Bulletin 08-24-16 (November 1, 2024) says licensed dietitian-nutritionists are among the personnel who can generate a billable FQHC or RHC encounter. If you work at a health center, the visit is billed as the center's encounter, not as your own S9470 line.
Managed care (HealthChoices)
Most Pennsylvania MA beneficiaries are enrolled in a HealthChoices managed care organization. The bulletin tells providers in managed care to take payment questions about CNWMS to the MCO. MCOs contract and credential on their own terms and may pay codes the fee-for-service schedule doesn't, so ask each plan:
- Do you credential licensed dietitian-nutritionists?
- Which codes do you pay: S9470, 97802/97803, or both?
- Are adults covered for nutrition counseling, and for which diagnoses?
- Is a referral or authorization needed?
How to verify a Pennsylvania MA member's benefits
- Eligibility and plan through PROMISe or the MCO. See 270/271 eligibility checks.
- Age: under 21 for the fee-for-service CNWMS benefit.
- Reason for the visit: a documented weight management problem.
- The MCO's codes and rules, if the child is in HealthChoices.
- Record the rep's name, date and reference number (verification call script).
Adults looking for weight-related nutrition counseling usually have more options through commercial plans' preventive benefits; see weight loss nutrition counseling coverage.
Not legal or billing advice. DHS updates bulletins and fee schedules; check the current fee schedule and the member's MCO before billing.