Primary Care Coding Alert

Question: Are DSMT and MNT services covered benefits in an FQHC?


Washington Subscriber

Answer: Yes. When a certified provider (a registered dietician or nutrition professional) furnishes diabetes self-management training (DSMT) and medical nutrition therapy (MNT) at a federally qualified health center (FQHC), Medicare permits coverage of these services.

The Deficit Reduction Act of 2005 amended the Social Security Act to add DSMT and MNT to the list of Medicare-covered and -reimbursed services under the FQHC benefit.
 
The DSMT codes are G0108, Diabetes outpatient self-management training services, individual, per 30 minutes; and G0109, Diabetes self-management training services, group session (2 or more), per 30 minutes.

The MNT codes are 97802, Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes; 97803, ... reassessment and intervention, individual, face-to-face with the patient, each 15 minutes; and 97804, ... group (2 or more individuals), each 30 minutes.

Great news: DSMT and MNT services are now considered core FQHC services and are reimbursable as a visit under the FQHC all-inclusive payment rate. For services in 2006, claims will generate an FQHC visit payment. Prior to Jan. 1, 2006, CMS allowed FQHCs certified as DSMT and MNT providers to bundle the cost of such services into their FQHC payment rates.

Go online: For more details, read MLN Matters Number: MM4385 available from www.cms.hhs.gov/MLNMattersArticles.