Home
Billing codes
97803

PAYER POLICY CHANGES

97803 Insurance Policy Changes

CPT 97803, in plain terms, covers Follow-up individual medical nutrition therapy visit with reassessment and intervention, reported per 15 minutes. CPT 97803 is referenced in 18 tracked payer policy changes from Anthem BCBS, Maryland Medicaid, and 9 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 97803 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 97803 on AAPC

Anthem BCBS · Effective Dec 1, 2026High impact
[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Effective December 1, 2026, Anthem will no longer reimburse outpatient medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling services (HCPCS G0421, G0447) when billed on UB-04 facility claim forms. These services are only reimbursable when submitted by the rendering provider on CMS-1500 professional claim forms using the applicable codes. Participating providers cannot balance bill members for this change.
Anthem BCBS · Effective Dec 1, 2026High impact
[Ohio] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Effective December 1, 2026, Anthem will no longer reimburse outpatient medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling services (HCPCS G0421, G0447) when billed on UB-04 facility claims. These services are now eligible for reimbursement ONLY when submitted by the rendering provider on CMS-1500 (professional claim form). Billing teams must route these services to the correct claim form type to avoid denials.
Anthem BCBS · Effective Dec 1, 2026High impact
[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility
Effective December 1, 2026, Anthem will no longer reimburse medical nutritional therapy (CPT 97802–97804; HCPCS G0270–G0271) and obesity counseling services (HCPCS G0421, G0447) when billed on UB-04 (facility claims). These services are now eligible for reimbursement ONLY when submitted on CMS-1500 (professional claim form) by the rendering provider. Billing teams must immediately audit billing workflows to prevent claim denials and ensure correct claim form submission.
Maryland Medicaid · Effective Mar 3, 2026High impact
PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines
Maryland Medicaid has updated coding guidelines for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), clarifying billing procedures for multiple encounters per day and specifying different trigger codes for MCO versus Fee-for-Service claims. The policy details specific submission requirements for somatic, mental health, substance abuse, and dental services.
Connecticut Medicaid (HUSKY Health) · Effective Jul 1, 2025High impact
2025.18 - Provider Bulletin - New Coverage of Medical Nutrition Therapy
Connecticut Medicaid (CMAP/HUSKY Health) adds coverage and reimbursement for medical nutrition therapy (MNT) services for specific diagnosis codes, when rendered by a certified and enrolled dietitian-nutritionist, effective for dates of service July 1, 2025, in accordance with Public Act Number 23-94. MNT is billed with 97802 (initial assessment and intervention, individual, 15 minutes, $25.61), 97803 (reassessment and intervention, 15 minutes, $22.34), or 97804 (group of two or more individuals, 30 minutes, $11.73), together with one of the primary diagnosis codes on Table 26, and is limited to 3 hours per calendar year per HUSKY Health member. Dietitian-nutritionists must be certified by the Department of Public Health and enrolled with CMAP, and their services must be recommended, referred or ordered by a licensed and enrolled practitioner.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Parenteral (PEN) and Enteral (EN) Nutrition Support in the Home
Intestinal failure-associated liver disease, ICD-10 K76.83, was added to the covered diagnosis codes effective 10/01/2026. Parenteral nutrition in the home is medically necessary for inanition from conditions such as Crohn's disease, obstruction, short bowel syndrome and malabsorption when the patient can receive no more than 30% of caloric needs orally or cannot benefit from enteral feedings. Enteral feeding is not medically necessary if 25% of estimated daily calories or less are being administered, except when transitioning off total parenteral nutrition.
Blue Cross Blue Shield of Vermont · Effective Aug 1, 2026Medium impact
Nutritional Therapy and Nutritional Counseling
Already effective 08/01/2026: Blue Cross VT's Medical Nutrition Therapy and Nutritional Counseling policy (10.01.VT205) considers these services medically necessary when a qualified healthcare professional provides them within the scope of their license and the Documentation Guidelines have been met. Services are considered not medically necessary when they are provided and the Documentation Guidelines have not been met. The plan will consider payment for up to one hour per session, and there is no limit on the number of sessions per member per plan year.
NY Medicaid · Effective Jul 1, 2026Medium impact
Rate Increases for Certain Services Delivered in Outpatient Settings certified by the Office of Mental Health, Office of Addiction Services and Supports and Office of People with Developmental Disabilities
Already effective July 1, 2026 for New York State Medicaid fee-for-service, and effective November 1, 2026 for Medicaid managed care plans, enhanced reimbursement applies to certain physical health services in OASAS, OMH and OPWDD certified outpatient clinics. Rates increase 20 percent for listed services in OASAS clinics, Article 31 MHOTRS clinics and Article 16 OPWDD clinics, and 20 percent for all services in Article 31 clinics for individuals eligible for the OPWDD waiver or enrolled in the TBI waiver. Services in OASAS Article 32 clinics for those individuals increase 50 percent.
Texas Medicaid · Effective Jul 1, 2026Medium impact
Updates to Prior Authorization for Services and Clinician-Administered Drug Benefits for HTW/HTW Plus
Effective July 1, 2026, Texas Medicaid will require prior authorization for MRI and other imaging services for HTW/HTW Plus programs, while adding new clinician-administered drug benefits. Several existing drug codes will no longer be covered HTW benefits.
Connecticut Medicaid (HUSKY Health) · Effective Jan 1, 2026Medium impact
2025.65 - Provider Bulletin - Medical Nutrition Therapy - Billing Update
Starting January 1, 2026, outpatient hospitals billing Medical Nutrition Therapy services to Connecticut Medicaid must use Revenue Center Code 942 (Other Therapeutic Services - Education/Training) in combination with MNT procedure codes. Claims must also include the certified dietitian-nutritionist as the rendering provider.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2026Medium impact
Payment policy updates
Multiple billing code changes effective at different dates: several codes becoming non-reimbursable for professional/facility services, CPT 77387 removed from non-reimbursable list for professionals, and unit limits removed for medical nutrition therapy codes. DME providers gain coverage for compression garment code A6548.
Blue Cross of Idaho · Effective Aug 1, 2025Medium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth
Blue Cross of Idaho updated FQHC billing requirements for Medicare Advantage patients, removing MMCP/IMP billing requirements and clarifying language for Chronic Care Management (CCM), Virtual Communication Services (VCS), Psychiatric Collaborative Care Model (CoCM), and telehealth services. FQHCs must continue using specific revenue codes and HCPCS codes for qualifying services under the CMS Prospective Payment System.
Blue Cross of Idaho · Identified Oct 6, 2026Medium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added language about preventive exams
Blue Cross of Idaho's FQHC billing policy for Medicare Advantage claims, with the September 2026 revision that added language on preventive exams. Preventive exams (CPT 99381 through 99387) are billed separately on a CMS-1500 claim, and FQHC qualifying visits need the right type of bill, revenue code and CMS payment HCPCS code, because claims missing any of these are denied and returned for correction. The policy text states no effective date of its own, so confirm the current rules on the payer's site.
Blue Cross of Idaho · Identified Sep 29, 2026Medium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added telehealth clarification
Blue Cross of Idaho's billing policy for federally qualified health centers (FQHCs) on Medicare Advantage claims, last revised September 2026 to add preventive exam language. FQHC qualifying visits must carry the right type of bill, revenue code and CMS payment HCPCS code, and claims missing any of these are denied and returned for correction, so the FQHC billing team needs to confirm its claim setup against the current list.
Aetna · Identified Aug 19, 2026Medium impact
Weight Reduction Programs and Devices (CPB 0039, reviewed 2026-03-10)
Aetna considers clinician-supervised weight reduction counseling for adults with a BMI of 30 or greater medically necessary up to a combined limit of 26 individual or group visits by any recognized provider per 12-month period. The FDA-cleared Plenity device is considered medically necessary to aid weight management in overweight and obese adults with a BMI of 25 to 40 kg/m2 when used with diet and exercise. For very low calorie diets (less than 799 kcal/day) in obese members, the listed EKG, lipid profile and chemistry tests are covered for up to 16 weeks, while exercise programs, special diet supplements, hospital confinement for a weight reduction program, and many experimental interventions such as wearable devices and sodium-glucose co-transporter 2 inhibitors are not covered or are considered experimental, investigational, or unproven for weight reduction.
Aetna · Identified Aug 18, 2026Medium impact
Nutritional Counseling (CPB 0049, reviewed 2026-03-10)
Aetna considers nutritional counseling a medically necessary preventive service for children and adults who are obese, and for adults who are overweight and have hypertension, dyslipidemia, impaired fasting glucose, or metabolic syndrome, when a provider recognized under the plan furnishes it. Aetna also considers counseling medically necessary for other chronic conditions where dietary adjustment has a therapeutic role, including diabetes, eating disorders, gastrointestinal disorders, hypertension, kidney disease, and seizures (ketogenic diet). Aetna considers counseling of unproven value for asthma, attention-deficit hyperactivity disorder, and chronic fatigue syndrome, and considers the NutrEval test experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Pediatric Intensive Feeding Programs (CPB 0809, reviewed 2025-12-11)
Aetna considers professional services for pediatric intensive feeding programs medically necessary for infants and children with complex feeding and swallowing disorders when an interdisciplinary team provides the care and every listed condition is met. Those conditions include behavior problems interfering with feeding, a documented diagnosis-specific treatment plan with estimated length of treatment, medical causes of failure to thrive treated without resolving the feeding problem, physician coordination and oversight, one of the listed feeding problems, and no response to initial treatment by a single discipline over a 2-month period. Other indications, such as childhood obesity and Prader-Willi syndrome, are considered experimental, investigational, or unproven, and electrical stimulation for swallowing or feeding disorders is also considered experimental, investigational, or unproven.
BCBS Arizona · Identified Jun 16, 2026Medium impact
Telehealth Services
BCBSAZ covers telehealth only as the member's benefit plan provides. Under the BlueCare Anywhere benefit, telehealth is covered when the Telehealth Services Administrator provides the service and determines the condition is appropriate, for a medical, therapy or psychiatry consultation. Under the in-network telehealth benefit, a service is covered when it would be covered in person and can be provided effectively by telehealth, through audio-visual services or limited audio-only services, and out-of-network non-emergency telehealth is not covered. The most recent review, dated 07/29/26, made no revisions.

Watch 97803

Get one email when a payer policy names 97803, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

REFERENCE DATA

Payers with rules4

Payers requiring prior auth4

CountyCare Health Plan · Effective April 23, 2026
Prior authorization required
CountyCare Prior Authorization Look-Up Tool (All Codes)
Anthem BCBS · Effective February 11, 2026
Prior authorization required
List of items and services that require prior authorization (Medicare)
CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for 97803?

Anthem BCBS lists 97803 on List of items and services that require prior authorization (Medicare) for medicare advantage plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 97803?

CalViva Health lists 97803 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 97803?

Community Health Plan of Imperial Valley lists 97803 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CountyCare Health Plan require prior authorization for 97803?

CountyCare Health Plan lists 97803 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 97803?

There are 18 tracked policy changes affecting CPT 97803, including updates from Anthem BCBS, Maryland Medicaid, Connecticut Medicaid (HUSKY Health). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 97803?

Payers that have issued tracked updates for CPT 97803 include: Anthem BCBS, Maryland Medicaid, Connecticut Medicaid (HUSKY Health), Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Vermont, NY Medicaid, Texas Medicaid, Blue Cross Blue Shield of Rhode Island, Blue Cross of Idaho, Aetna, BCBS Arizona.

How do I get notified when CPT 97803 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 97803. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 97803?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 97803

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 97803 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[Ohio] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines

2025.18 - Provider Bulletin - New Coverage of Medical Nutrition Therapy

Parenteral (PEN) and Enteral (EN) Nutrition Support in the Home

Nutritional Therapy and Nutritional Counseling

Rate Increases for Certain Services Delivered in Outpatient Settings certified by the Office of Mental Health, Office of Addiction Services and Supports and Office of People with Developmental Disabilities

Updates to Prior Authorization for Services and Clinician-Administered Drug Benefits for HTW/HTW Plus

2025.65 - Provider Bulletin - Medical Nutrition Therapy - Billing Update

Payment policy updates

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added language about preventive exams

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added telehealth clarification

Weight Reduction Programs and Devices (CPB 0039, reviewed 2026-03-10)

Nutritional Counseling (CPB 0049, reviewed 2026-03-10)

Pediatric Intensive Feeding Programs (CPB 0809, reviewed 2025-12-11)

Telehealth Services

Prior authorization required

Prior authorization required

Prior authorization required

Does Anthem BCBS require prior authorization for 97803?

Does CalViva Health require prior authorization for 97803?

Does Community Health Plan of Imperial Valley require prior authorization for 97803?

Does CountyCare Health Plan require prior authorization for 97803?

What insurance policy changes affect CPT 97803?

Which payers have updated policy for CPT 97803?

How do I get notified when CPT 97803 policy changes?

Why do payers change policies for CPT 97803?