Nutritional Counseling Program Overview
The nutritionist’s goals are to enable health care providers to treat obesity as a disease and bill accordingly. Ultimately, this will help reduce obesity rates in South Carolina and improve health outcomes.
Eligible Participants
- Adults with a Body Mass Index (BMI) of 30 or greater who are committed to losing weight through diet and exercise.
- Children with a BMI at the 95th percentile or greater will continue to be covered through the Medicaid Early Periodic Screening Diagnosis and Testing (EPSDT) program.
Program Benefits
The Nutritional Counseling Program includes:
- Six visits with a physician, physician assistant, and/or nurse practitioner
- Six visits with a licensed dietitian
Note: Patients must be referred by their health care provider to a licensed dietitian.
If you are already referring your Medicaid patients to a local licensed dietitian, that dietitian is eligible to provide nutritional counseling services. If you do not have access to a local licensed dietitian, one can be provided to you through a partnership with the Department of Health and Environmental Control.
Important Note for Pediatricians
- Reimbursement Amount:
- Licensed dietitians: $13.91 per 15-minute session ($27.82 daily max)
- Pediatricians: $22.76 per 15-minute session ($45.52 daily max)
- Billing Guidelines:
- Nutritional counseling units billed for pediatrics are based on 15-minute time unit sessions, limited to two per day with a maximum of 12 per year.
- Pediatricians must bill the appropriate level of Evaluation and Management (E&M) service codes (99201–99215) if obesity is diagnosed during the EPSDT visit.
Frequently Asked Questions
Who is eligible to participate in the Nutritional Counseling Program?
Adults with a BMI of 30 or higher are eligible, as well as children at or above the 95th percentile BMI, who are covered under the Medicaid EPSDT program.
How many counseling sessions are covered under this program?
Eligible participants can receive six visits with a physician, physician assistant, or nurse practitioner, and six additional visits with a licensed dietitian, per year.
Do patients need a referral to access a licensed dietitian?
Yes, patients must be referred by their health care provider to a licensed dietitian in order to receive nutritional counseling services under this program.
What are the reimbursement rates for nutritional counseling sessions?
Licensed dietitians receive $13.91 per 15-minute session (up to $27.82 daily), while pediatricians are reimbursed $22.76 per 15-minute session (up to $45.52 daily).
What are the billing limits for pediatric nutritional counseling?
Pediatric providers can bill for up to two 15-minute sessions per day, with a maximum of 12 sessions per year. Proper E&M codes (99201–99215) must be used if obesity is diagnosed during an EPSDT visit.