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MNT CPT and G Codes and Definitions

Medicare Medical Nutrition Therapy CPT Codes and Definitions
On January 1st, 2001, the American Dietetic Association (ADA) announced three new current procedural terminology codes (CPT) for medical nutrition therapy (MNT). The codes were recognized by the Centers for Medicare & Medicaid Services (CMS) and are included in the American Medical Association’s (AMA) Current Procedural Terminology CPT book.

The MNT CPT codes are unique codes for medical nutrition therapy provided by dietetics professionals. Compared with other CPT codes, the MNT CPT codes best describe the services that dietetics professional provide to patients/clients receiving medical nutrition therapy services for a particular disease or condition. The codes can be used among private insurance companies, depending on the coding and billing details listed in the dietetics professionals’ contract with the insurance plan. Additionally, CMS requires use of these codes for the Medicare MNT benefit by RD providers who perform MNT services for diabetes and non-dialysis kidney disease. The codes are described as:

97802: Medical nutrition therapy*; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97803: Re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97804: Group (2 or more individual(s)), each 30 minutes

CMS also established additional codes for use with Medicare covered services, effective for dates of service on or after January 1, 2003. These new G codes should be used when additional hours of MNT services are performed beyond the number of hours typically covered, (3 hours in the initial calendar year, and 2 follow-up hours in subsequent years with a physician referral) when the treating physician determines there is a change of diagnosis or medical condition that makes a change in diet necessary.

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 interventions(s) following second referral in 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.

Other factors to consider with the Medicare MNT benefit Malpractice insurance RDs must have malpractice insurance as providers of the Medicare MNT Benefit. One of the companies to contact for information about malpractice insurance is Marsh (toll free 877-687-0845, #2).

MNT payment
CMS determined the payment amount for Medicare MNT as the lesser the actual charge for the services or 85% of the physician fee schedule amount. Of this amount, Medicare pays 80% of the amount and the Medicare beneficiary pays a 20% co-payment amount. The Medicare beneficiary is also responsible for the Medicare deductible payment. RDs can access current Medicare payment rates from the Medicare carrier's Web page or CMS’ Web page. When reviewing the 2004 Physician Fee Schedule from the carrier's Web page, RDs need to remember to take 85 percent of the "par amount" (the participating provider amount) listed for each of the MNT codes — 97802, 97803 and 97804.

Definitions in the Medicare MNT benefit proposed regulations Medical nutrition therapy
The Medicare MNT benefit regulations defines medical nutrition therapy (MNT) services as nutritional diagnostic, therapy, and counseling services provided by a registered dietitian or nutrition professional for the purpose of managing disease. Covered services for the Medicare MNT benefit will consist of nutrition assessment, interventions, reassessment, and follow-up interventions.

Qualifying providers of MNT services
The Medicare MNT benefit defines registered dietitian or nutrition professional as an individual who meets the following criteria:

Holds a bachelor’s degree or higher by a regionally accredited college or university in the U.S. (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 by the Secretary for this purpose;
Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional
Is licensed or certified as a dietitian or nutrition professional by the State in which the services are performed, or, if a State does not provide for licensure or certification, meets other criteria established by the Secretary.
Grandfathers dietitians or nutrition professionals licensed or certified as 12/21/01.

Covered diseases/conditions
CMS covers Medicare MNT for two diseases/conditions — diabetes mellitus Type 1 and Type 2, gestational diabetes, chronic renal insufficiency (non-dialysis), and kidney post-transplant care after discharge from the hospital.

Who can refer beneficiaries to the RD for MNT services?
A physician referral, indicating the diagnosis and medical necessity for MNT for diabetes or non-dialysis kidney disease is required for the benefit. The Physician, as a treating physician, is defined as the primary care physician or specialist who is coordinating care for the beneficiary with diabetes or renal disease.

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