Medical Nutrition Therapy

Effective Date: July 6, 2022

Purpose:

This policy provides guidelines on reimbursement of Medical Nutrition Therapy (MNT).

Scope:

Products included:

  • NJ FamilyCare/Medicaid
  • MLTSS

Definitions:

Medical nutrition therapy services means nutritional diagnostic, therapeutic, and counseling services provided by a registered dietitian or nutrition professional for the purpose of managing diabetes or a renal disease.

  • CPT code 97802: Medical nutrition therapy; initial assessment and intervention, face-to-face with the patient, each 15 minutes

  • CPT code 97803: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes

  • CPT code 97804: Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes

  • HCPCS code 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

  • HCPCS code 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 (2 or more individuals), each 30 minutes

Policy:

Horizon NJ Health will deny CPT codes 97802-97804 or G0270-G0271 (MNT) when billed by a provider other than a registered dietician, nutritional professional, or hospital.

Procedure:

Horizon NJ Health will not consider for reimbursement MNT services (CPT codes 97802-97804 or G0270-G0271) when billed by a provider other than a registered dietician, nutritional professional, or hospital.

CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until the Policy is reviewed and updated to reflect the new or amended coding.

Limitations and Exclusions:

Notwithstanding the foregoing, all payment determinations are subject to all other, applicable limitations, including but not limited to, the following:

  • Benefit Limitations;
  • The terms of any applicable provider participation agreement;
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic;
  • Medical necessity; and
  • Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

References:

American Medical Association, Current Procedural Terminology (CPT®) Professional Edition and associated publications and services

CMS National Coverage Determination (NCD) 180.1, effective 01/01/2022 https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=252