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AetnaAll Plans · Coverage · Medical Policy · Family Medicine, Internal Medicine, Endocrinology +3 moreMedium impact

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

Effective date
Not stated in the notice
Identified
Aug 18, 2026

Summary

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.

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What to do

Action · 7 steps
01Billing team: Check the benefit plan description before billing, because some plans require referrals for nutritional counseling.
02Bill nutritional counseling only when it is furnished by a provider recognized under the plan, such as a licensed nutritionist, a registered dietitian, or another qualified licensed health professional such as a nurse trained in nutrition.
03Bill the CPT and HCPCS codes listed in the policy only when the selection criteria are met.
04Bill the ESRD-related monthly codes by patient age group and by the number of face-to-face physician visits per month, for example 90951 for 4 or more visits and 90953 for 1 visit for patients younger than 2 years of age.
05Bill the diagnosis codes for obesity, eating disorders, and BMI only for the indications the policy lists, and for overweight (E66.3) and BMI 25.0 to 29.9 (Z68.25 to Z68.29) only for adults who also have other cardiovascular disease risk factors.
06Claims for ADHD (F90.0 to F90.9), asthma (J45.20 to J45.909), and chronic fatigue (R53.82) are not covered for nutritional counseling.
07NutrEval has no specific code and is considered experimental, investigational, or unproven.

Codes mentioned

909519095290953909549095590956909579095890959909639096490965978029780397804G0108G0109G0270G0271G0447G0473S9470E66.01E66.2E66.811E66.9E66.3F50.00F50.9Z68.25Z68.29Z68.30Z68.45Z68.53Z68.54F90.0F90.9J45.20J45.909R53.82

Original notice

Nutritional Counseling (CPB 0049, reviewed 2026-03-10)
aetna.com · Always check the source before changing claims.
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