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Nutritional Therapy and Nutritional Counseling
Effective date
Aug 1, 2026
Identified
Jun 19, 2026
Summary
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.
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What to do
Action · 10 steps
01Already effective 08/01/2026: Billing team should confirm that each visit's documentation meets the Documentation Guidelines, because these services are considered not medically necessary when those guidelines are not met.
02Assessment documentation must include a comprehensive review of nutritional status, including medical diagnoses and history, relevant lab results and medications, weight, waist circumference, food journals, patient interview responses about food preferences, food restrictions or allergies, cultural needs, social determinants of health and current diet, and clinical information indicating pertinent medical care.
03The treatment plan must be individualized with the member and include specific, measurable, attainable, relevant and time-based goals, short and long-term goals with documented progress, recommended dietary or behavioral changes, educational materials used, and the rationale for each recommendation.
04Progress notes must document the type of intervention, progress toward health targets, updated progress on goals, and follow-up sessions in a standard format such as a SOAP note.
05Document the start and end time of each visit and any collaboration with other healthcare providers.
06Documentation cannot be copied, pasted, or forwarded from a past encounter into the current progress note, and all notes must be signed, physically or digitally, with the date and time.
07Units are limited to up to 4 per visit for CPT 97802, CPT 97803 and HCPCS G0270, up to 2 per visit for CPT 97804 and HCPCS G0271, up to 1 per year for HCPCS G0537, and up to 1 per visit for HCPCS S9470.
08Prior approval may be required, and incomplete authorization requests may delay a decision until the missing information is submitted.
09Verify member benefits before providing the service, because FEP, ASO and NEHP/ABNE members may have different benefits.
10If an audit finds non-compliance, Blue Cross VT reserves the right to recoup all non-compliant payments.
Codes mentioned
978029780397804G0270G0271G0537S9470
Original notice
Nutritional Therapy and Nutritional Counseling
bluecrossvt.org · Always check the source before changing claims.