Avoiding Denials In Nutrition Therapy: Correct Cpt & Hcpcs Code Usage

By Author: Charlie Robinson
Total Articles: 63
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Are your Medical Nutrition Therapy (MNT) claims facing frequent denials?
Do you know which CPT and HCPCS codes to apply to secure proper reimbursement?
For many practices, denials happen because of simple errors—like choosing the wrong code, missing a referral, or failing to include complete documentation.
Even small mistakes, such as misreporting session time or selecting an incorrect code, can cost your practice hundreds—or even thousands—of dollars in lost revenue.
With chronic conditions such as diabetes, kidney disease, and other health issues steadily increasing, mastering accurate MNT coding has never been more critical.
This blog will walk you through a step-by-step process for correctly applying CPT and HCPCS codes for Medical Nutrition Therapy, helping you reduce denials and secure maximum reimbursement.
Step 1: Choose the Correct Code
Successful billing for Medical Nutrition Therapy (MNT) starts with selecting the appropriate CPT or HCPCS code. The right choice depends on whether the visit is an initial assessment, a follow-up session, or a reassessment triggered by ...
... a change in the patient’s condition.
CPT Codes for MNT
• 97802 – Used for the initial one-on-one assessment and intervention. Each unit covers 15 minutes and applies only to the patient’s first visit.
• 97803 – Applies to follow-up individual sessions, also billed in 15-minute increments, ensuring continued care for ongoing nutrition therapy.
• 97804 – Designed for group sessions (two or more patients) and billed in 30-minute units. This code can be used for both initial and follow-up group visits.
HCPCS Codes for Special Cases
• G0270 – For individual reassessments or interventions when a patient receives an additional referral within the same year due to a new diagnosis, change in condition, or modified treatment plan. Each unit covers 15 minutes.
• G0271 – For group reassessments in similar circumstances, billed in 30-minute units.
Pro Tip: Use CPT codes for standard initial and follow-up visits, and switch to G-codes only when there’s a documented change in the patient’s condition or a new referral. Proper code selection reduces denials and ensures billing compliance.
Step 2: Calculate Units Accurately
Proper reimbursement depends on correctly calculating billing units based on the actual time spent with the patient. Since each CPT or HCPCS code is tied to a specific time frame, assigning the right number of units is crucial for accurate claims.
Unit Guidelines for Individual and Group Sessions
• 97802 / 97803 (Individual sessions): Each unit represents 15 minutes. For instance, a 45-minute initial visit should be billed as three units of 97802.
• 97804 / G0271 (Group sessions): Each unit equals 30 minutes. For example, a two-hour group session would be billed as four units of 97804.

Step 3: Bill Under the Nutritionist’s Credentials (Not Incident-To)
Medical Nutrition Therapy (MNT) codes are designated for Registered Dietitians (RDs) and other licensed nutrition professionals. These services should not be billed as “incident-to” a physician, as this is a common cause of claim rejections.
Use the Nutrition Professional’s NPI/PIN
When filing claims, always include the nutritionist’s own National Provider Identifier (NPI) or Provider Identification Number (PIN). Submitting claims under a physician’s NPI can result in denials and may even increase the risk of payer audits.
Why Not “Incident-To”?
“Incident-to” billing is intended for specific services provided by non-physicians under direct physician supervision. Since MNT codes are tied directly to nutrition professionals, reporting them as incident-to a physician is inaccurate and will likely lead to payment denials.
Step 4: Confirm Payer-Specific Guidelines
Medical Nutrition Therapy (MNT) coverage can differ widely between Medicare, Medicaid, and private health insurance providers. Verifying each payer’s requirements before delivering services is crucial to minimize denials and prevent patients from facing unexpected out-of-pocket costs.
Medicare Coverage
Medicare covers MNT for individuals diagnosed with diabetes, chronic kidney disease, or those who have received a kidney transplant within the past three years. In the first year, patients may access up to three hours of therapy, followed by two hours annually in subsequent years. Additional sessions are approved only when there is a documented change in the patient’s condition or treatment plan, billed with G0270 or G0271 codes. For eligible patients, copayments, coinsurance, and deductibles are waived, ensuring full access to essential services.
Private Insurance Coverage
Policies among commercial insurers vary considerably. Some offer a set annual allowance for MNT services, while others restrict coverage to specific diagnoses. Many private plans also require a physician referral along with proof of medical necessity. Securing written confirmation of each payer’s coverage terms is a best practice to avoid denied claims and protect patients from surprise charges.
Step 5: Documentation
Thorough documentation plays a vital role in justifying claims, proving medical necessity, and meeting payer compliance standards.
Diagnosis Records
The ICD-10 code must clearly represent the patient’s condition and be accepted by the payer. For example, E11.9 is assigned for diabetes. Accurate diagnosis coding not only validates medical necessity but also reduces the risk of claim denials.
Referral Records
All MNT services require a physician referral. In Health Maintenance Organizations (HMOs), a referral certificate number may be necessary, whereas Preferred Provider Organizations (PPOs) generally accept a standard physician referral. A copy of the referral should always be kept in the patient’s file for claim support and audit purposes.
Time Records
Document the exact start and end times of every session in the patient’s chart. This ensures that billed units align with the time spent and provides verification during audits. Accurate time documentation also prevents reimbursement issues and strengthens claim approval.
Step 6: Use Correct Billing Forms & Follow Site-Specific Guidelines
Submitting claims on the right forms and complying with facility-specific rules are key to ensuring accurate reimbursement.
CMS-1500 Form
MNT services should be reported using the CMS-1500 claim form. Each CPT or HCPCS code must be listed on its own line, along with the correct number of units, session time, and the corresponding ICD-10 diagnosis code.
Federally Qualified Health Centers (FQHCs)
In FQHCs, individual nutrition therapy sessions qualify as reimbursable encounters. Even when separate payment isn’t issued, providers should still document CPT/HCPCS codes to maintain compliance and accurate patient records.
Rural Health Clinics (RHCs)
Within RHCs, MNT services are usually included in the all-inclusive encounter rate. While separate reimbursement may not apply, coding and documentation are still required to ensure compliance and to support audits in the future.
Step 7: Track Denials and Make Adjustments
Even with accurate coding and thorough documentation, claim denials can still happen. Keeping a close watch on submitted claims helps practices quickly identify mistakes, resolve issues, and optimize reimbursement.
Frequent Causes of Denials
Common reasons include incorrect CPT/HCPCS code selection, missing physician referrals, errors in unit calculation, improper use of provider identifiers, or submitting claims for conditions not covered by the payer.
Managing Denials
Every denied claim should be thoroughly reviewed to determine the cause. When necessary, submit additional documentation and resubmit corrected claims. Establishing a clear denial management system not only improves payment recovery but also prevents similar mistakes from recurring.
Ongoing Audits
Routine audits of MNT billing help uncover patterns, correct recurring problems, and ensure adherence to payer guidelines. Consistent auditing strengthens revenue cycle efficiency and minimizes the risk of future denials.
Conclusion
Securing proper reimbursement for Medical Nutrition Therapy (MNT) depends on precise coding, thorough documentation, and compliance with payer guidelines. Selecting the right CPT or HCPCS codes, accurately tracking session time, and billing under the nutrition professional’s credentials are all critical to minimizing claim denials.
However, even with best practices in place, MNT billing can still be complex due to varying insurance requirements and coverage limitations. Partnering with 24/7 Medical Billing Services can simplify this process. Their experts carefully review claims, verify code accuracy, address potential errors, and reduce denials—ensuring nutrition therapy services are reimbursed correctly and on time.

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