Improving Health and Outcomes of Medicare beneficiaries

Beginning January 1, 2002, Medicare now covers outpatient medical nutrition therapy (MNT) provided by Registered Dietitians (RDs) for Medicare beneficiaries with diabetes or non-dialysis kidney disease. Passage of the Medicare Part B MNT benefit is a major achievement for consumers who rely on the Medicare program for their health care. MNT improves patient outcomes and saves healthcare costs by reducing or eliminating prescription drugs and hospital admissions.

Referring physicians can take simple steps to ensure their patients are eligible and can access MNT provided by an RD. A physician order to see an RD is required for the benefit during each calendar year when nutrition services are needed. The order should include the diabetes or non-dialysis kidney disease diagnosis code(s) and indicate the medical necessity for MNT provided by the RD. Physicians should also document this information in the patient's medical chart. Certain conditions may require additional MNT visits beyond the number of visits listed in national protocols, such as the American Dietetic Association MNT Evidence-Based Nutrition Practice Guidelines/Protocols. In these cases, the referring physician should write another referral for MNT, and document the order and change of condition in the patient's chart.

RDs, as new Medicare providers with their own provider identification numbers, will use CPT MNT procedure codes 97802, 97803 and 97804 for the service. Claims for MNT for diabetes or non-dialysis kidney disease may be submitted to the Medicare carrier on a CMS1500 form or UB92-for hospitals providing MNT in their outpatient settings. Hospital billing departments must list both the RD's Medicare provider identification number (PIN) and the referring physician's Medicare UPIN on the claims form before submitting it to the Medicare carrier.

Physicians can direct their Medicare patients with diabetes or kidney disease to call the local hospital or physician offices for an MNT appointment with an RD. The American Dietetic Association (ADA) can also help locate RDs in the community; call 800/877-1600, ext. 5000 or visit ADA web site to "Find an Nutrition Professional" and enter your zip code in the left-hand search bar.