Wiki Medical Nutrition Codes Limitations

[nikiac95@gmail.com]

Hi all,

I am wondering if someone can provide some additional information on the Medical Nutrition Therapy Codes 97802-97804. I know that CPT 97802 can only be billed ONCE per calendar year for the initial assessment of a new patient, but are there limitations for the other two codes, 97802 and 97803? I keep finding conflicting information. On CMS(https://www.cms.gov/medicare-covera...supports,for beneficiaries with renal disease) I see that MNT has a number of covered hours of 3 and for FU MNT the number of hours covered is 2. Does this mean that 97802 can only be covered 3x per calendar year?

Then on some sites, I see that it is covered with no limitations. I want to make sure that benefits are correct and if there is a limitation that it is billed correctly/denied accordingly. Any help on this would be greatly appreciated.

 

[CBLENNIE]

Are you only asking about Medicare or are you asking about all insurance companies? Coverage of MNT is probably going to be different for each of your commercial insurance companies. Even some MA plans may offer more coverage of MNT than traditional Medicare, MA plans have to provide the minimum covered by traditional Medicare but can provide more extensive/comprehensive benefits than traditional Medicare.

 

[nikiac95@gmail.com]

Are you only asking about Medicare or are you asking about all insurance companies? Coverage of MNT is probably going to be different for each of your commercial insurance companies. Even some MA plans may offer more coverage of MNT than traditional Medicare, MA plans have to provide the minimum covered by traditional Medicare but can provide more extensive/comprehensive benefits than traditional Medicare.

Thank you for your response. I was asking with regard to commercial insurance(s). So the 3 limit is really for Medicare but commercial plans and MA can offer more?

 

[CBLENNIE]

That is correct. You will likely need to check the benefits for each patient because benefits are likely going to be different from carrier to carrier and even within the same carrier, they may offer different plans that cover more or less MNT than other plans they offer. This is particularly true with self-funded employer sponsored plans, which tend to have more customized benefits.

 

[nikiac95@gmail.com]

Thank you for that, i just wanted to make sure that 3 limit wasn’t universal and you helped me see that it wasn’t, so thank you for your response. I truly appreciate it.