Medical Nutrition Therapy and Medicare

Medicare Part B helps to cover services from healthcare providers, outpatient care, (including Registered Dietitian Nutritionist doing Medical Nutrition Therapy (MNT)), medical equipment (wheelchairs and walkers) and preventative services such as vaccines and screenings.  

It is important to note that Medicare also covers MNT for certain  patients with Medicare Part B who meet the following criteria:

•  Referred by a physician (MD or DO) who is enrolled as a PECOS (Provider Enrollment Chain and Ownership System)

• Diagnosed with diabetes or renal disease, stages 3-5 not on dialysis or had kidney transplant within last 36 months

• Delivered service by registered dietitian or nutrition professional 

All Claims must have only the diagnosis covered with the ICD 10 approved codes to the highest specificity and use the Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes. The current HCPCS and CPT codes for MNT are as follows: 

• 97802- Medical Nutrition therapy; initial assessment and intervention, individual, face-to-face with 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 (2 or more individual(s)), each 30 minutes 

• G0270- Medical Nutrition Therapy; reassessment and subsequent intervention(s) following the second referral in the same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with patient, each 15 minutes 

• G0271- Medical Nutrition Therapy; reassessment and subsequent intervention(s) following the second referral in the same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes 

Each client can receive 3 hours of 1-on-1 MNT counseling and for subsequent years is 2 hours. Note this benefit is client specific.  Therefore, if the client ever received counseling for either diabetes or renal disease by another RDN provider, they are considered follow-up—limit of 2 hours for the calendar year, even if they are new to you as a new client. This benefit is preventative and therefore, the clients pay no co-pay or are not subject to deductible.

Furthermore, Diabetes Self-Management Training (DSMT) and MNT cannot be billed on the same service date for the same patient, or incident to a physician’s or nurse practitioners, physician assistants or clinical nurse specialists (NPP’s) professional services.