Starting a Dietitian Private Practice in the US: What Changes by State

What does every US dietitian have to do, regardless of state?

Five things. The credential, the NPI and the HIPAA billing test are federal; the rest vary by state. First, hold the RDN credential. The Commission on Dietetic Registration issues it on accredited coursework, supervised practice and its examination, and since 2024 on a graduate degree for anyone establishing exam eligibility. RD and RDN are its trademarks. Second, find out what your state does with that credential, because the federal Medicare rule looks to the state credential first and to CDR registration second. Third, obtain a Type 1 National Provider Identifier, which a sole proprietor applies for with a Social Security number. Most payers ask for it, though not all: Medicare’s patient claim form asks for it only "if known", and the Premera and Aetna member forms on the receipts page do not ask for it. Fourth, choose a business structure, and check the state's entity statute rather than assuming the license decides it. Fifth, decide whether you will bill insurers electronically, because that decision, not your profession, decides whether HIPAA governs your practice.

The state decides whether the RDN alone lets you counsel a paying client. The billing decision decides which federal privacy regime you are in. In some states the entity filing needs a licensing-board certificate before the state will accept it. And the state decides whether the fee you charge is taxed at all. The sections below take them in that order, each with the page that carries the state-by-state detail.

Do I need a state license to practice as a dietitian?

It depends on the state. Twenty states and the District of Columbia reserve some part of the practice to licensees, though Illinois, North Carolina, Georgia, Montana, North Dakota and Nebraska reserve only medical nutrition therapy and allow unlicensed wellness counseling, and Michigan joins them when its prohibition commences. Eleven states license dietitians but protect only the title, so an unlicensed person may practice if they do not hold themselves out as licensed; Texas's regulator says in terms that no license is needed to practice dietetics in Texas. Six states certify a title only. Arizona, California, Colorado and Virginia issue no credential, though California makes misuse of "RD" a misdemeanor and Colorado treats claiming to be a "dietitian" without the credential as a deceptive trade practice. Seven states' statutes read two ways and are left unresolved. Hawaii's statute could not be read, and New Jersey's board has issued no licenses yet.

Five jurisdictions rewrote their acts between 2023 and 2026: Georgia, Montana, Nebraska, the District of Columbia and Michigan. Georgia protected "nutritionist" for the first time, and Michigan re-enacted licensure with a prohibition that starts about October 2027. Arizona and Colorado both passed licensure and their governors vetoed it. The Illinois, New Mexico and Maryland acts carry expiry dates. Whether "nutritionist" is a protected word is decided state by state, and the answer for each is in the table on the licensure page.

All fifty states and DC, with what each regulates, which words it protects and what an unlicensed person may sell, are in licensure and protected titles by state.

Can I see clients in other states by telehealth?

Not through the compact yet, and otherwise only where the client's state allows it. The Dietitian Licensure Compact activated in March 2025, is enacted in nineteen states, and its Commission states that "compact privileges are not yet being issued"; its rules committee was still discussing the draft privilege rule in August and September 2026. When it is live, a privilege will require a license in the dietitian's home state, so a practice based in Arizona, California, Colorado or Virginia cannot use it at all. Until then, a client physically in a practice-exclusive state generally needs that state's license: North Carolina, Iowa, Illinois, Maryland, Alabama and DC say so expressly, and Georgia and Montana add narrow temporary-presence exemptions. Texas requires no license to serve a Texas client unless the dietitian uses "licensed dietitian" or "LD" with them. Florida, Delaware and Vermont offer a telehealth registration instead of a license. West Virginia's interstate telehealth statute requires a registration and names the dietitian article, but its process for dietitians could not be verified. Florida's registration requires liability coverage, which the state's form fixes at $100,000 per claim.

The compact’s status, the enacting states, and a state-by-state telehealth table are in the compact and telehealth across state lines.

Does HIPAA apply to my practice, and if not, what does?

HIPAA applies only if the practice, or anyone acting for it, transmits a covered transaction such as a claim or eligibility check in electronic form. A cash-pay dietitian who issues superbills for clients to submit themselves is not a covered entity, and emailing clients or using cloud software does not change that. One electronic claim does, and so does a billing service sending one on the practice's behalf. The status does not reverse later. A covered practice must publish a Notice of Privacy Practices, conduct a risk analysis, name a security official, train its workforce, and hold business associate agreements with every vendor that touches protected health information.

A practice outside HIPAA is still reached by state privacy law and the FTC Act. Texas's medical-records-privacy chapter defines "covered entity" as anyone who stores or uses protected health information for fees, with no small-practice exemption, and requires training within 90 days of hire, electronic records within 15 business days of a request, and posted instructions in the office and on the website. Washington, Nevada and Connecticut consumer-health-data laws have no size threshold and carve out only entities HIPAA already regulates. The FTC Act reaches a sole proprietor directly. California's medical-information act may or may not reach a California RD; the statute does not say. And every state breach law applies on its own terms, with deadlines of 30 days in California, New York and Florida and no HIPAA relief at all in Texas.

The covered-entity test, what a covered practice must do, the state overlays and five states’ breach deadlines are in whether HIPAA applies to a private-practice dietitian.

How long do I have to keep client records?

In most states no rule sets a period for a dietitian's records, and the only binding one found is New York's. HIPAA's six years applies to policies and compliance documentation, not to medical records, and HHS says so in its own FAQ. Medicare requires seven years of ordering and referral documentation, which on its face includes a referred nutrition-therapy service, and Medicare Advantage plans impose ten years by contract. Of sixteen states examined, only New York sets a period that binds a private-practice dietitian today: six years, and for minors six years and until one year past age 21. Michigan's seven years will bind its licensees: applications are due on or before October 17, 2027, and the practice restriction starts October 27, 2027. Florida, Pennsylvania, Ohio and Illinois require records and state no period. Georgia, North Carolina and Massachusetts have no dietitian rule. Texas has none for the chart, only five years for telehealth consent records, and Washington's only duty is one year after an authorization to disclose. The "Texas 7 years" and "Florida 5 years" figures on retention charts are physician rules that never bound dietitians.

The sixteen-state table, the borrowed physician figures set aside, and the limitation periods that argue for keeping records longer are in how long a US dietitian must keep client records.

Will insurance pay for my services?

Medicare will, for two diagnoses. Part B medical nutrition therapy covers diabetes and renal disease, the latter defined as a glomerular filtration rate of 15 to 59, end-stage disease without dialysis, or the 36 months after a transplant, on a referral from a doctor of medicine or osteopathy, for three hours in the first calendar year and two in each subsequent year. An enrolled dietitian is paid 80 percent of the lesser of the charge or 85 percent of the fee schedule, must accept assignment on every claim, must submit every claim, and may opt out only for all Medicare patients for two years at a time. Dietitians are permanent telehealth practitioners, and the any-location flexibility runs to December 31, 2027.

Commercial coverage is set by the member's plan document, and admission to a network is discretionary. Neither Aetna's nor UnitedHealthcare's criteria name dietitians. The ACA requires no-cost coverage of USPSTF grade A and B services, which include obesity interventions and diet counseling for adults with cardiovascular risk factors, but a plan with a network may impose cost sharing on services delivered out of network, so the benefit rarely reaches a cash-pay practice. Medicaid takes three shapes in five large states, from a direct dietitian benefit in New York to no named benefit in Florida. Whatever the client's plan, the superbill they submit has no federal field list. Medicare wants an NPI and no tax ID, Premera a tax ID and no NPI, and Aetna's member section neither, though its provider section asks for both.

The Medicare rules and 2026 code table, the ACA carve-out, credentialing and five states’ Medicaid are in which US insurers cover dietitian services. What goes on the client’s bill, the telehealth codes and the HSA and FSA test are in what goes on a US dietitian superbill.

Should I form an LLC, and will my fees be taxed?

An LLC changes nothing on federal income tax: a single-member LLC is disregarded and files the same Schedule C, with self-employment tax of 15.3 percent on 92.35 percent of net profit. The S corporation is a separate election on Form 2553 that requires reasonable compensation before any distribution and comes with no IRS safe-harbor percentage. Whether the state lets a dietitian use an ordinary LLC, requires a professional one, or bars both turns on the state's entity statute, not on the license: Ohio, Georgia and North Carolina license dietitians and leave them out of their professional-entity lists, New York requires an education-department certificate before the filing, Illinois requires a licensing-department certificate per location, and California is unresolved.

Sales tax on the counseling fee applies in Hawaii and New Mexico, which tax gross receipts, and in no other state where the answer could be verified, as of September 2026. Two states are not a clean "no": Delaware taxes the seller’s gross receipts and the dietitian classification could not be determined, and West Virginia is unresolved. Washington reaches the fee too, but through the business-and-occupation tax on the practice rather than a tax charged to the client. The traps are New York City's salon tax, Washington's webinar tax and downloadable meal plans. New York City taxes "weight control and health salons" locally, and Washington made live webinars and workshops a retail sale from October 1, 2025, while excluding one-on-one consulting. A downloadable meal plan is taxable in Washington, Pennsylvania and Connecticut, not in California, and undetermined in Ohio and New Jersey. Local business taxes in Los Angeles, San Francisco, Philadelphia, New York City, Portland and Seattle reach a solo practice, and several of the figures in circulation changed in 2025 and 2026.

The federal rules and sixteen states’ entity positions are in LLC, PLLC or sole proprietor for a US dietitian; the state, digital-product, supplement and city tax tables are in whether dietitians charge sales tax in the US.

How do the largest states compare?

Eleven states, one row each, drawn from the spoke pages. Every cell is a summary of a cited finding on the linked page; "unresolved" means the statute reads two ways and no authority has settled it, and "none found" means the rule was searched for and does not exist.

The Canadian map is in starting a dietitian private practice in Canada, where the title is restricted everywhere, the professional corporation is available in four provinces, and the records clock runs on one of six different events depending on the province.