- 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
Preventive Services Guide
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.
Table of Contents
- Eligibility Criteria
- Coverage Criteria
- HCPCS/CPT Coding
- Diagnosis Coding
- Who Can Perform?
- Cost Sharing
- Reimbursement
- Nonparticipating Providers
- Common Claim Denials
- Related Content
Eligibility Criteria
To be eligible for MNT, the beneficiary must have:
- diabetes,
- renal disease, or
- received a kidney transplant within the last 36 months and
- received a referral from a physician.
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; 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
- 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
Who Can Perform?
- Registered dietitian or nutrition professional who meets provider qualification requirements
Cost Sharing
- Coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
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 100-04, Medicare Claims Processing Manual, Chapter 4, Section 300
- National Kidney Disease Education Program
- NCD for Medical Nutrition Therapy
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 9/27/2024