Insurance coverage · Coverage

Texas Medicaid nutrition counseling

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

The short answer

Texas Medicaid's rules for dietitians live in the Texas Medicaid Provider Procedures Manual (TMPPM), published by TMHP and updated monthly. In the September 2026 edition, licensed dietitians bill medical nutrition therapy in two programs:

1. Comprehensive Care Program (CCP), the Texas Medicaid program for children and young adults 20 and under.
2. Healthy Texas Women (HTW), which added nutrition counseling on December 1, 2024.

For adults in the main managed care programs (STAR, STAR+PLUS), we did not find a TMPPM dietitian MNT benefit comparable to CCP's. Ask the member's plan what it covers, including value-added services.

CCP: what the manual says

Section 2.11 of the Children's Services Handbook, "Medical Nutrition Counseling Services (CCP)", sets these conditions. Nutrition counseling is a benefit when all of the following are true:

• The client is 20 years of age or younger and CCP-eligible
• The services are prescribed by a physician
• They're performed by a Medicaid-enrolled licensed dietitian (licensed by TDLR)
• Clinical documentation supports medical necessity

A case manager, school counselor or school nurse can refer the client, but the physician's prescription is still required.

Conditions where MNT may be considered beneficial include abnormal weight gain, cardiovascular disease, diabetes or altered blood glucose, eating disorders, GI disorders, gastrostomy, hypertension, inherited metabolic disorders, kidney disease, lack of normal weight gain, multiple food allergies and nutritional deficiencies. Not a benefit: ADHD, chemical sensitivities, chronic fatigue syndrome, idiopathic environmental intolerance, and obesity without a comorbid condition.

Limits per rolling year:

S9470 is denied when billed on the same date of service as 97802, 97803 or 97804. Prior authorization is required to exceed the limits or to consider conditions the policy doesn't address, using the CCP Prior Authorization Request Form with a treatment plan, diagnosis, obstacles to goals and planned interventions; the physician-signed form is valid for up to six months.

Documentation must include objective and subjective data; height, weight, BMI and growth-curve percentiles; estimated caloric needs; the nutrition diagnosis; intervention and plan; and evaluation. Group sessions add the physician prescription, location, goals, participation and start and end times.

Healthy Texas Women

The HTW Program Handbook lists 97802, 97803, 97804 and S9470 as HTW benefits. They don't need prior authorization up to these quantities per rolling year: 97802, 4 units; 97803, 12 units; 97804, 8 units; S9470, 1 visit. TMHP announced the benefit in its October 2024 notice, effective for dates of service on or after December 1, 2024.

Telehealth

• Modifier 95 for synchronous audio-video delivery.
• Modifier 93 for synchronous telephone (audio-only), where audio-only is allowed.
• For HTW, TMHP's notice said audio-only nutrition services are covered only during certain public health emergencies or natural disasters. The CCP section likewise limits audio-only delivery of the MNT codes to those situations, while it lists S9470 as authorized for audio-video and, when noted, audio-only delivery. Either way, providers must document why a visit was done audio-only.

Telehealth rules change; re-read the current handbook section before billing audio-only. General guidance is in telehealth billing for dietitians.

Managed care: one plan's rule is not the state's

Most Texas Medicaid members are in managed care. Plans follow the TMPPM but can publish their own coding and billing policies. The best-known 2026 example: Community First Health Plans announced that, effective August 3, 2026, it covers MNT (97802, 97803, 97804, G0270, G0271) only with a diagnosis of diabetes mellitus, renal disease or kidney transplant, and denies other diagnoses.

That rule applies to Community First's members. Some billing websites repeat it as a Texas-wide or even national Medicaid rule. It isn't. But it's a signal worth taking seriously: check each MCO's provider updates, because the plan can be stricter than the manual.

How to verify a Texas Medicaid member's benefits

1. Eligibility: confirm Medicaid or HTW eligibility and the managed care plan (STAR, STAR Kids, STAR+PLUS, CHIP) through TMHP or the plan. See 270/271 eligibility checks.
2. Program: is the client 20 or under (CCP) or an HTW client? Adults outside HTW need the plan's own answer.
3. Prescription: do you have the physician's prescription for CCP services?
4. Units used: how many 97802/97803/S9470 units remain in the rolling year? Ask the plan.
5. MCO policy: does the member's plan limit diagnoses (like Community First) or require prior authorization?
6. Telehealth: audio-video with 95; confirm before any audio-only visit.
7. Record the rep's name, date and reference number (verification call script).

For dietitians: claim tips

• Enroll as a CCP provider (independently practicing licensed dietitian) before contracting with MCOs. See insurance credentialing step by step.
• Don't bill S9470 with 97802–97804 on the same day. More on the code at S9470.
• Track units per rolling year, not per calendar year.
• Get prior authorization before exceeding a limit; see prior authorization for nutrition services.
• Obesity alone isn't a CCP benefit; document the comorbid condition when there is one.

Not legal or billing advice. TMHP updates the TMPPM monthly; check the current handbook and the member's plan before billing.