Skip to Main Content
 
 
 
Web Content Viewer

Policy Education Topics

Web Content Viewer
Web Content Viewer

Medical Nutrition Therapy Tool for Billing

CMS considers DSMT and MNT complementary services. This means Medicare will cover both DSMT and MNT without decreasing either benefit as long as the referring physician determines that both are medically necessary. However, keep in mind that DSMT and MNT will not be allowed by Medicare when performed and billed for on the same date of service.

Medical Nutrition Therapy

MNT is a dietary intervention that is used to prevent or treat health conditions that are caused by or made worse by unhealthy eating habits.

Section 105 of the BIPA Act of 2000 permits Medicare coverage of MNT services when furnished by a registered dietitian or nutrition professional.

A treating physician must make a referral and indicate a diagnosis of diabetes or renal disease.

MNT programs are credentialed with Medicare. Since MNT is not a separately recognized provider type, providers cannot enroll in Medicare for the sole purpose of providing MNT.

Health professionals are medical professional such as, health educators, registered dietitians, or nutrition professionals or other licensed practitioner or a team of such medical professionals, working under the direct supervision (as defined in 42 CFR 410.32(b)(3)(ii)) of a physician as defined in this section. 

A dietitian professional may not be the sole provider of the DSMT and MNT services; however, there is an exception for rural areas. In a rural area, an individual who is qualified as a registered dietitian and as a certified diabetic educator who is currently certified by an organization approved by CMS may furnish training and is deemed to meet the multidisciplinary team requirement. This exception is currently being waived for all dietitian professionals due to the public health emergency for COVID-19.

Registered dietitian or nutrition professional meets the following criteria

    • Minimum of Bachelor of Science degree in nutrition or dietetics
    • Completion of 900 hours of dietetics practice under supervision of registered dietitian or nutrition professional
    • Licensed or certified as a dietitian or nutrition professional by state in which services are performed (federal employees can be licensed or certified in any state)
    • Registered dietitian credential with the CDR is proof that education and experience requirements are met
    • Grandfathered dietitian, nutritional professionals licensed or certified as of 12/21/2000

Registered dietitians and nutritionists should use nationally recognized protocols such as the American Dietetic Association’s MNT Evidenced-Based Guides for Practice.

The performing provider must be enrolled as a Medicare Part B Provider.

Beneficiary Qualifications

    • Diabetes:
      • Diagnosed with Type 1, Type 2 or Gestational
      • Diabetes is a condition of abnormal glucose metabolism diagnosed using the following criteria:
        • FBS > 126 mg/dl on two different occasions
        • Two-hour post-glucose challenge > 200 mg/dl on two different occasions; or, a random glucose test over 200 mg/dl for a person with symptoms of uncontrolled diabetes
    • Renal:
      • Non-dialysis kidney disease
      • Post-kidney transplants
    • Referral from their treating provider

Billing Medicare

    • Hospital Outpatient Provider-based Clinic:
      • Form CMS-855B, Medicare Enrollment Application for Clinics/Group Practices and Certain Other Suppliers
    • Enroll in Medicare Part B, registered dieticians or nutrition professionals complete:
      • Form CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners
    • Registered dieticians or nutrition professionals reassign Medicare benefits to employer:
      • Form CMS-855R, Medicare Enrollment Application for Reassignment of Medicare Benefits
    • Electronic Enrollments Via:

Coverage Criteria

The MNT benefit provides coverage for:

    • three hours of one-on-one services for first year and
    • two hours of coverage each subsequent year.

Hours are based on calendar year and cannot be carried over from year to year.

    • Additional hours may be covered based on medical necessity when ordered by the treating physician; a second referral is required if the number of hours covered in an episode of care are exceeded
    • The treating provider must provide a referral that includes the diagnosis of diabetes or renal disease.
    • Services can be provided either individually or within a group.
    • You cannot bill DSMT and MNT on the same date of service for the same beneficiary.
    • MNT is not covered for beneficiaries receiving maintenance dialysis.

 MNT covered services for disease management include:

    • An initial nutrition and lifestyle assessment
    • Nutritional counseling
    • Information regarding diet management
    • Follow up sessions to monitor progress

HCPCS/CPT Coding

    • 97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
    • 97803: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
    • 97804: Medical nutrition therapy; group (two or more individual(s), each 30 minutes
    • G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes
    • G0271: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), group (two or more individuals), each 30 minutes

Diagnosis Coding

Cost Sharing

    • Coinsurance applied
    • Deductible applied

Reimbursement:

Nonparticipating Providers

    • Nonparticipating reduction applies
    • Limiting charge provision applies

Common Claim Denials

    • Beneficiary not qualified to receive benefit
    • Individual provider of MNT services did not meet provider qualification requirements

References

Related Associations and Contact Information

American Diabetes Association (ADA)
2451 Crystal City Drive
Suite 800
Arlington, VA 22202
Phone: 800-342-2383

Association of Diabetes Care & Education Specialists (ADCES)
125 S. Wacker Dr.
Suite 600
Chicago, IL 60606
Phone: 800-338-3633

Promote Diabetes Awareness and Encourage Patients to take Advantage of the DSMT/MNT Programs

Published 1/27/2021

Medical Nutrition Therapy Tool for Billing
Web Content Viewer
Web Content Viewer
Complementary Content