- Diabetes Screening
- Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
- Diabetes Self-Management Training
- Diabetic Self-Management Tool for Billing
- DSMT: Documentation & Physician Order Requirements
- Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy
- Common Questions for Diabetes Self-Management Program Accreditation
- Medical Nutrition Therapy
- Medical Nutrition Therapy Tool for Billing
- Common Denials Guide for Diabetes Self-Management Training and Medical Nutrition Therapy
- Medicare Diabetes Prevention Program
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.
Table of Contents
- Medical Nutrition Therapy
- Registered dietitian or nutrition professional meets the following criteria
- Beneficiary Qualifications
- Billing Medicare
- Coverage Criteria
- HCPCS/CPT Coding
- Diagnosis Coding
- Cost Sharing
- Reimbursement
- Nonparticipating Providers
- Common Claim Denials
- Related Content
- Related Associations and Contact Information
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 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.
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 a 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
- 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 a physician; a second referral is required if the number of hours covered in an episode of care are exceeded
- The 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 waived
- Deductible waived
Reimbursement:
- MPFS: Fee Schedule Lookup Tool
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
Related Content
- CMS IOM Publication 100-03, National Coverage Determinations Manual, Chapter 1, Part 3, Section 180.1
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 4
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18
- MLN®Educational Tool: Medicare Preventive Services
- eatright® Academy of Nutrition and Dietetics
Related Associations and Contact Information
- American Diabetes Association (ADA)
- Phone: 800-342-2383
- Association of Diabetes Care & Education Specialists (ADCES)
- Phone: 800-338-3633
Reviewed 09/17/2024