Procedure performed for CPT code 97802, 97803 & 97804

A dietetic professional provides medical nutrition therapy assessment or re-assessment and intervention in a face-to-face or group patient setting. After nutritional screening identifies patients at risk, preventive or therapeutic dietary therapy is initiated to induce a positive result in the role nutrition plays in improving health outcomes. CPT code 97802 is reported for the initial assessment and intervention face-to-face with an individual patient for each 15 minutes of medical nutrition therapy.

Procedure codes 97802 and 97803 are not restricted to patients 20 years of age or younger; they may be submitted for patients of any age.

CPT code 97803 is reported for re-assessment and intervention with an individual patient for each 15 minutes of Medical Nutrition Therapy (MNT).

CPT code 97804 is reported for group medical nutrition therapy provided for two or more individuals, each 30 minutes.

Read also: Fosphenytoin dose, injection, side effects and brand name

Description of CPT code 97802, 97803 & 97804

Medical Nutrition Therapy; a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a registered dietitian. The diet is based upon the patient’s medical and psychosocial history, physical examination, functional examination and dietary history.

The Medical Nutrition Therapy  (MNT) CPT codes  are used in sequence, starting with the initial, individual MNT assessment and intervention (CPT code 97802), then the subsequent use of MNT CPT codes for either individual reassessment and intervention (CPT code 97803) or group intervention (97804). An individual assessment and evaluation is routinely performed to determine whether patients are candidates for group MNT.

97802  Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes

This code is to be used only once a year, for initial assessment of a new patient. All subsequent individual visits (including reassessments and interventions) are to be coded as 97803. All subsequent Group Visits are to be billed as 97804.

97803  re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes

This code is to be billed for all individual reassessments and all interventions after the initial visit (see 97802). This code should also be used when there is a change in the patient’s medical condition that affects the nutritional status of the patient (see the heading, Additional Covered Hours for Reassessments and Interventions).

97804  group (2 or more individual(s)), each 30 minutes

This code is to be billed for all group visits, initial and subsequent. This code can also be used when there is a change in a patient’s condition that affects the nutritional status of the patient and the patient is attending in a group.

For Medicare-covered MNT services, CMS established two HCPCS level II G-codes for MNT reassessment and subsequent intervention following a second referral in the same calendar year for a change in diagnosis, medical condition, or treatment regimen.

G- codes are used to identify professional health care procedures and services for which there are no specific CPT codes. According to a Medicare Intermediary Program Memorandum (Transmittal A-02-115), dated November 1, 2002, “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.”

Note: Check with your carriers or local third-party payers for their specific reporting guidelines regarding these services

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 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

Medical nutritional therapy codes (97802, 97803, S9470) may be billed when counseling patients on obesity or weight management. These codes are compatible with any diagnosis but are most appropriate or intended for illness or disease-related diagnoses such as obesity or diabetes. Code 97804 is nutritional therapy in a group setting.

Group therapy services are generally only covered when submitted with diagnosis codes for anorexia, bulimia, diabetes, congestive heart failure and some maternity diagnosis codes. Outpatient hospital eating disorder services are billed under revenue code 0942 and CPT code 97802, 97803 and 97804.

Licensed dietitians and licensed nutritionists can bill for procedure/service codes S9470, 97802, 97803, and G0447 for diagnosis codes other than eating disorders.

Services and diagnosis (ICD-10 CM) codes covered by AETNA

For Medical Necessity, Aetna considers nutritional counseling a medically necessary preventive service for children and adults for obesity and for adults other risky diseases like overweight, cardiovascular diseases, hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome. These nutritional counseling should be prescribed by a physician and furnished by a provider (e.g., licensed nutritionist, registered dietician, or other qualified licensed health professionals such as nurses who are trained in nutrition) recognized under the plan.

For chronic diseases like diabetes mellitus, eating disorders, gastro-intestinal disorders, hypertension, kidney disease, seizures (i.e., ketogenic diet), and other conditions (e.g., chronic obstructive pulmonary disease) in which dietary adjustment has a therapeutic role, aetna considers nutritional counseling medically necessary only when it is prescribed by a physician and furnished by a provider who is a licensed nutritionist, registered dietician, or other qualified licensed health professionals such as nurses who are trained in nutrition and recongnized under a plan.

ICD 10 diagnosis covered under Aetna if all above criteria are met