97804 CPT® code: payer coverage and prior authorization97804 appears in 14 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Capital Blue Cross, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Autism Spectrum Disorders (0648) | not covered (range 97802-97804) | Oct 2, 2025 | payer document |
| Aetna | Diabetes Tests, Programs and Supplies (0070) | listed, no stance | Feb 20, 2026 | payer document |
| Aetna | Fecal Incontinence (0611) | listed, no stance (range 97802-97804) | Sep 23, 2026 | payer document |
| Aetna | Hospitalization for the Initiation of Ketogenic Diet (0226) | listed, no stance (range 97802-97804) | Apr 23, 2026 | payer document |
| Aetna | Intensive Cardiac Rehabilitation Programs (0267) | listed, no stance (range 97802-97804) | May 14, 2026 | payer document |
| Aetna | Nutritional Counseling (0049) | covered if criteria are met | Mar 10, 2026 | payer document |
| Aetna | Pediatric Intensive Feeding Programs (0809) | listed, no stance | Dec 11, 2025 | payer document |
| Aetna | Tourette's Syndrome (0480) | not covered (range 97802-97804) | Jul 24, 2026 | payer document |
| Aetna | Weight Reduction Programs and Devices (0039) | covered if criteria are met | Mar 10, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Parenteral Pen And Enteral En Nutrition Support In The Home (L.1.01.404) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Nutritional Counseling/Medical Nutritional Therapy | covered if criteria are met | Feb 19, 2008 | payer document |
| Capital Blue Cross | Intensive Pediatric Feeding Programs (MP 2.079) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Premera Blue Cross | Preventive Care | covered if criteria are met | Sep 21, 2026 | payer document |
| UnitedHealthcare | Preventive Care Services (MP.016.59) Children and Adolescents | Medical Nutrition Therapy: | listed in this row for 0403T, 97802- | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in WA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.