• Services covered include education, training and counseling on nutrition, foot care, exercise, and drug regimen monitoring.



• Providers of diabetes education and training services must be Certified Diabetes Educators per the American Diabetes Association criteria. 










Medical Nutrition Therapy (MNT) CPT codes


The list of Medicare telehealth services has been expanded to include individual MNT as described by HCPCS codes G0270, 97802 and 97803. Effective January 1, 2006, the telehealth modifiers “GT” (via interactive audio and video telecommunications system) and modifier “GQ” (via asynchronous telecommunications system) are valid when billed with these HCPCS codes. This expansion to the list of Medicare telehealth services does not change the eligibility criteria, conditions of payment, payment or billing methodology applicable to Medicare telehealth services


CPT 97802, 97803, 97804, G0270, G0271


Services must be provided by a registered dietitian or nutrition professional


No specific diagnosis code Contact the local Medicare Contractor for guidance


Certain Medicare beneficiaries diagnosed with diabetes, renal disease, or who have received a kidney transplant within the last three years


• 1st year: 3 hours of one-on-one counseling
• Subsequent years: 2 hours




MEDICAL NUTRITION THERAPY (MNT)   CLINICAL NUTRITION THERAPY


Service          Time             CPT Code


Initial Assessment And Intervention


This Code Can Be Used Only Once A Year For First Appointment


Medical Nutrition Therapy (MNT) 15 minutes 97802


Initial Assessment and Intervention 15 minutes 97802


Face to Face with the Patient 15 minutes 97802




NOTE: CPT codes 97802 and 97803 should be unit priced; four units = 60 minutes, and six units = 90 minutes. Six or more units will be priced at six units For Insurance Claim use the term “Medical nutrition therapy,” which is another term for clinical nutrition therapy..


NOTE: CPT codes 97802 and 97803 should be unit priced; four units = 60 minutes, and six units = 90 minutes. Six or more units will be priced at six units.

Description:


Nutritional counseling/Medical Nutritional Therapy (MNT) is an important part of the prevention and treatment of many diseases and conditions. It consists of a nutritional assessment, the assignment of a specific diet, counseling services, and/or specialized therapies to treat an illness or condition. Nutritional counseling/MNT is covered when ordered by a physician and provided by a Registered Dietitian/Nutritionist to treat an illness or medical condition in which MNT is proven to be effective for treatment. 




Diabetes Management:


Visits for Nutritional Counseling/MNT are not counted as part of the visits for diabetes education as defined in the Diabetes Treatment Mandatebenefit. For information relating to the diabetic mandate, please refer to the policy titled: Diabetes Treatment Mandate.


For information relating to nutritional management of diabetes by a Certified Diabetes Outpatient Education (CDOE) specialist please refer to the Diabetes Self-Management Education Mandate.


Coding:


The following codes are covered only when services are provided by a Registered Dietician/Nutritionist for all lines of business:


97802 Medical Nutrition Therapy (MNT) 15 minutes 
97803 All Subsequent Individual Appointments 15 minutes 
97804 Initial Group Appointments 30 minutes or  Subsequent Group Appointments 30 minutes 




Six or more units will be priced at six units for CPT codes 97802 and 97803.


Three or more units will be priced at three units for CPT code 97804. 


Medical nutritional therapeutics codes (97802, 97803, S9470) may be billed when counseling patients on obesity or weight management. These codes are compatible with any diagnosis but are most intended for illness or disease-related diagnoses such as obesity or diabetes.



Use the suitable code from 97802–97804. These codes should be reported only for services provided by nutritionists. If a physician provides medical nutrition therapy, the E/M or preventive services codes should be usefulness. Private payers may also understand HCPCS digest S9452, S9465 or S9470 for a session of nutrition therapeutics provided by a nutritionist.

Medicare payment


Prior to 01/01/11:
• Copayment/coinsurance applies
• Deductible applies

On or after 01/01/11:
• Copayment/coinsurance waived
• Deductible waived



Payment for MNT Services




The contractor shall pay for MNT services under the physician fee schedule for dates of service on or after January 1, 2002, to a registered dietitian or nutrition professional that meets the above requirements. Deductible and coinsurance apply. As with the diabetes self management training (DSMT) benefit, payment is only made for MNT services actually attended by the beneficiary and documented by the provider, and for beneficiaries that are not inpatients of a hospital or skilled nursing facility.


The contractor shall pay the lesser of the actual charge, or 85 percent of the physician fee schedule amount when rendered by a registered dietitian or nutrition professional. Coinsurance is based on 20 percent of the lesser of these two amounts. As required by statute, use this same methodology for services provided in the hospital outpatient department.




A. Payable Codes for MNT with Applicable Instructions


• 97802 – Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes. (NOTE: This HCPCS code must only be used for the initial visit.)


• This code is to be used only once for the initial assessment of a new patient. The provider shall bill all subsequent individual visits (including reassessments and interventions) as 97803. The provider shall bill all subsequent group visits as 97804.


• 97803 – Re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes


• The provider shall bill this code for all reassessments and all interventions after the initial visit (see 97802). This code should also be used when there is a change in the patient’s medical condition that affects the nutritional status of the patient (see the heading, Additional Covered Hours for Reassessments and Interventions).


• 97804 – Group (2 or more individual(s)), each 30 minutes


• The provider shall bill this code for group visits, initial and subsequent. This code can also be used when there is a change in a patient’s condition that affects the nutritional status of the patient and the patient is attending in a group.


NOTE: The above codes can be paid if submitted by a registered dietitian or nutrition professional who meet the specified requirements; or a hospital that has received reassigned benefits from a registered dietitian or nutritionist. These services cannot be paid “incident to” physician services.







Allowed Units.



Clients receive an approval letter with an authorization number for dietitian visits; four units for the initial visit (CPT 97802) and two units for subsequent visits twice a month for 6 months (97803). You must bill with the authorization number on the claim. If you have questions about the authorization number and the span of dates approved, call MACSC (see Important Contacts).For dietitian visits billed in the outpatient setting, use the appropriate revenue code. However, do not use revenue code 942 which is used for diabetic education only.


The agency covers the following procedure codes listed below.


CPT Code Brief Description Policy/Limits


97802 Medical nutrition, indiv, initial 1 unit=15 minutes Maximum of 2 hours (8 units) per year
97803 Medical nutrition, indiv, subseq 1 unit=15 minutes Maximum of 1 hour (4 units) per day
97804 Medical nutrition, group 1 unit=15 minutes Maximum of 1 hour (4 units) per day


The following CMS-1500 Claim Form instructions relate to medical nutrition therapy: Field No. Name Entry 24B Place of Service Use the appropriate code(s): Code # To be used for 11 12 22 Office Home Outpatient hospital 24G Days or Units Enter:


* 97802, not more than 8 units per year.
* 97803, not more than 4 units per day.

* 97804, not more than 4 units per day.