Contractor Name 

National Government Services, Inc.  

Contractor Number 

Contractor Type 

Carrier

FI 

Article ID Number 

A46071 

Article Type 

Article

Key Article 

Yes

Article Title 

Medical Nutrition Therapy (MNT) Services – Medical Policy Article

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association.© 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Primary Geographic Jurisdiction 

Secondary Geographic Jurisdiction 

Not applicable 

Original Article Effective Date 

12/01/2007

Article Revision Effective Date 

Article Text 

Billing Instructions for Medical Nutrition Therapy
Medical Nutrition Therapy services are covered as of January 1, 2002, for patients with diabetes or renal disease.

The initial episode of MNT is for 3 hours the first year and 2 hours each additional year, but additional hours may be covered beyond the hours typically covered under an episode of care when the treating physician determines there is a change of diagnosis or medical condition within such episode of care that makes a change in diet necessary.

MNT Service can be billed to FIs when performed in an outpatient hospital setting. The Hospital outpatient departments can bill for MNT services through the local FI if the nutritionists or registered dietitians reassign their benefits to the hospital.

The only applicable bill types are 13X, 14X, 23X, 32X and 85X.

ICD-9-CM Codes That Support Medical Necessity

For patients with diabetes:

250.00-250.03 Diabetes mellitus without mention of complication
250.10-250.13 Diabetes with ketoacidosis
250.20-250.23 Diabetes with hyperosmolarity
250.30-250.33 Diabetes with other coma
250.40-250.43 Diabetes with renal manifestations
250.50-250.53 Diabetes with ophthalmic manifestations
250.60-250.63 Diabetes with neurological manifestations
250.70-250.73 Diabetes with peripheral circulatory disorders
250.80-250.83 Diabetes with other specified manifestations
250.90-250.93 Diabetes with unspecified complication
648.80-648.84 Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium, abnormal glucose tolerance

For patients with renal disease:

403.0 Hypertensive Chronic Kidney disease, malignant
403.1 Hypertensive Chronic Kidney disease, benign
403.9 Hypertensive Chronic Kidney disease, unspecified
585.1 Chronic kidney disease, Stage I
585.2 Chronic Kidney disease, Stage II (mild)
585.3 Chronic Kidney disease, Stage III (moderate)
585.4 Chronic Kidney disease, Stage IV (severe)
585.5 Chronic Kidney disease, stage V
585.6 End stage renal disease
585.9 Chronic Kidney disease, unspecified
593.9 Unspecified disorder of kidney and ureter

For patients who had successful kidney transplant:

V42.0 Organ or tissue replaced by transplant, kidney

Claims submitted for any other conditions will be denied as not medically necessary under Section 1862(a)(1)(A) of the SSA.

Coverage Topic 

Nutrition Therapy Services (Medical)
 

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CPT/HCPCS Codes 

Other Comments 

References:

• CMS Manual System, Pub 100-3, National Coverage Determinations, Section 180.1.
• CMS Manual System, Pub 100-4, Medicare Claims Processing, Chapter 4, section 300-300.6.