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25.3.2 Benefits, Limitations, and Authorization Requirements
The CSHCN Services Program provides coverage for nutritional assessment and counseling to prevent, treat, or minimize the effects of illness, injury, or other impairments.
Nutrition assessment and counseling services are a benefit of the CSHCN Services Program when:
• Prescribed by a physician.
•Documentation supports medical necessity or appropriateness.
•Completed by a CSHCN Services Program-enrolled dietitian licensed by the Texas State Board of Examiners of Dietitians.
•Services are provided in the home, office, or in the outpatient hospital setting.
Medical nutrition therapy (procedure codes 97802 and 97803) and nutrition counseling services, dietician visit (procedure code S9470) may be beneficial for disease states in which dietary adjustment has a therapeutic role. This includes, but is not limited to, the following conditions:
•Abnormal weight gain
•Cardiovascular disease
•Diabetes or alterations in blood glucose
•Eating disorders
•Gastrointestinal disorders
•Hypertension
•Inherited metabolic disorders
•Kidney disease
•Lack of normal weight gain
•Nutritional deficiencies
Nutrition intervention for chronic fatigue syndrome, attention-deficit hyperactivity disorder, idiopathic environmental intolerances, and multiple food and chemical sensitivities is considered experimental and investigational and is not a benefit of the CSHCN Services Program.
Medical nutritional counseling service for the diagnosis of obesity without a comorbid condition is not a benefit of the CSHCN Services Program.
Nutrition counseling, dietitian visit (procedure code S9470) is a less comprehensive service and does not include an assessment or reassessment. This is limited to one service per day at a maximum of two per rolling year.
Procedure codes 97802, 97803, and S9470 are not restricted to clients 20 years of age or younger; they may be submitted for clients of any age. Services may be provided in the home, office, or outpatient hospital settings.
The CSHCN Services Program reimburses procedure codes 97802, 97803, and S9470. If procedure codes 97802 or 97803 are billed for the same date of service as S9470, procedure code 97802 or 97803 is paid and procedure code S9470 is denied. Procedure code 97803 will be denied as part of another service when billed for the same date of service as procedure code 97802, by any provider.
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