- 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
Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
Table of Contents
- Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
- Who Can Bill for DSMT
- Billable Codes for Diabetes Self-Management Training
- Who Can Bill for Medical Nutrition Therapy
- Billable Codes for Medical Nutrition Therapy
- Billing Tips for DSMT and MNT Services
- Related Content
Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
National Government Services, your MAC, has received questions regarding who can bill for DSMT and MNT services. We wanted to assist you by clarifying who is classified as a certified provider for these diabetes preventive programs. Below you will find information on who can bill for DSMT and MNT services, as well as applicable codes, and additional resources.
Who Can Bill for DSMT
A designated, certified provider is an individual or entity that can bill for DSMT services through an accredited program. If the program is not accredited by the ADA or ADCES, then the claims will be denied.
Who is considered a certified provider? A certified provider is considered:
- Physician or other individual or entity that:
- Provides outpatient self-management training services as well as other items and services for which payment may be made under the Medicare Program.
- All providers/suppliers billing Medicare for other individual services are considered certified.
- RNs and pharmacists can furnish the training; however, they are not eligible for Medicare enrollment, and must work with another certified provider to bill on his/her behalf.
- Registered dietitians are eligible to bill on behalf of an entire accredited DSMT program (must have a Medicare provider number – specialty 71).
Billable Codes for Diabetes Self-Management Training
| Code | Description |
|---|---|
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes. |
| G0109 | Diabetes outpatient self-management training services, group session (two or more), per 30 minutes. |
Who Can Bill for Medical Nutrition Therapy
For MNT services, only a registered dietitian or nutrition professional may provide the services. “Registered dietitian or nutrition professional” means a dietitian or nutritionist licensed or certified in a State as of 12/21/2000 (they are not required to meet any other requirements); or an individual whom, on or after 12/22/2000:
- Holds a bachelor’s or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics, as accredited by an appropriate national accreditation organization recognized for this purpose. The academic requirements of a nutrition or dietetics program may be completed after the completion of the degree;
- Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional. Documentation of the supervised dietetics practice may be in the form of a signed document by the professional/facility that supervised the individual; and
- Is licensed or certified as a dietitian or nutrition professional by the State in which the services are performed. In a State that does not provide for licensure or certification, the individual will be deemed to have met this requirement if he or she is recognized as a “registered dietitian” by the Commission on Dietetic Registration or its successor organization.
- The registered dietician/nutrition professional must be enrolled as a provider in the Medicare program and meet the requirements listed above. Additionally, they must accept assignment for the service, the limiting charge does not apply.
Billable Codes for Medical Nutrition Therapy
| Code | Description |
|---|---|
| 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97803 | Medical nutrition therapy; reassessment 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 |
Billing Tips for DSMT and MNT Services
- DSMT benefit is stand-alone and billable service separate from Initial Preventive Physical Examination.
- DSMT and MNT benefits allowed for the same beneficiary, in the same year but not on same day.
- DSMT and MNT require separate referrals from physicians.
- Make sure to include the NPI of the referring physician on the CMS-1500 claim form.
- Billing an E/M code is not mandatory before billing the DSMT procedure codes. Do not use E/M codes in lieu of HCPCS codes G0108 and G0109
Related Content
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Preventive and Screening Services
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services
- MLN® Educational Tool: Medicare Preventive Services
- Diabetes Awareness Educational Topics
Reviewed 09/17/2024