CSHCN Services Program 2010 > Medical Nutrition Services > Medical Nutritional Counseling Services

25.3.2.1 Prior Authorization Requirements

Prior authorization is required for additional visits. Requests for additional visits require medical review and must be submitted in writing on form CSHCN Services Program Prior Authorization Request for Additional Nutritional Assessment, Counseling, and Products with documentation to support medical necessity or appropriateness. An example of the form is available in Appendix B, on page B-5.

Authorization or prior authorization is not required for the following nutritional counseling services:

•One hour (four units) of nutrition assessment and intervention (procedure codes 97802 and 97803) per rolling year.

•Two nutrition counseling visits (procedure code S9470) per rolling year.

Providers are responsible for maintaining documentation to support medical necessity of nutritional counseling services in the clinical record.

Use procedure codes 97802, 97803, or S9470 when requesting prior authorization or submitting claims.

Note: Fax transmittal confirmations are not accepted as proof of timely authorization submission.

Refer to: Section 4.3, "Prior Authorizations" for detailed information about prior authorization requirements.