CPT Codes 97802 & 97803 for Medical Nutrition Therapy

cpt code 97802 descriptionCPT Code 97802 and CPT Code 97803 are the primary codes used for billing individual Medical Nutrition Therapy services.  Medical Nutrition Therapy (MNT) is a crucial service provided by registered dietitians and nutrition professionals to manage various health conditions. This guide covers the definitions, usage, billing procedures, documentation requirements, and common pitfalls associated with these codes.

If you don’t want to deal with these codes, consider reaching out to our billing service for help!

CPT Code 97802 & 97803 Descriptions

  • CPT Code 97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
    • Used for the first MNT session with a patient. This includes gathering detailed history, assessing nutritional status, and developing a personalized plan.
    • Can be billed even if the patient saw a different dietitian previously; it marks the initial assessment with you.
  • CPT Code 97803: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
    • Used for all subsequent follow-up MNT sessions after the initial 97802 visit.
    • Involves reassessing progress, adjusting the nutrition plan, and providing ongoing education and support.

CPT Code 97802 Reimbursement Rate (2025): $35.58

cpt code 97802 reimbursement rate

The above rate is set by CMS / Medicare each year.  This is a national rate, not adjusted by locality.  Your rate will differ based on your locality.

CPT Code 97803 Reimbursement Rate (2025):  $31.05

  • Reimbursement rates for 97802 and 97803 vary significantly depending on the insurance payer (private, Medicare, Medicaid) and geographic location.
  • It’s essential to verify coverage and rates with each payer (call them).
  • Medicare Part B: Covers MNT (using these codes) at 100% for patients with diabetes, chronic renal disease, or a kidney transplant within the last 36 months, provided there is a physician referral.
  • Medicaid: Coverage varies by state; some states may have specific limitations or may not recognize registered dietitians as providers for direct reimbursement.

Time Frame / Units for 97802 & 97803

  • Both 97802 and 97803 are time-based codes, billed in 15-minute units.
  • To bill for one unit, the service must last at least 8 minutes (past the midpoint).
  • Multiple units can typically be billed per session, reflecting the total face-to-face time spent. For example:
    • 4 units = 60 minutes
    • 6 units = 90 minutes
  • Payers, including Medicare, may have limits on the number of units billable per day or per year. (e.g., Medicare allows 3 hours of MNT in the first year, 2 hours in subsequent years, unless medical necessity dictates more).

Billing 97802 vs 97803

  • Use 97802 only for the initial assessment visit with a patient. It is typically billed only once per patient per calendar year (unless the patient hasn’t been seen in over a year or significantly changes status, check payer rules).
  • Use 97803 for all individual follow-up visits after the initial assessment.

Procedural Review

MNT services billed under CPT codes 97802 and 97803 are often associated with the following conditions:​

  • Diabetes mellitus
  • Chronic kidney disease
  • Obesity
  • Hypertension
  • Cardiovascular disease
  • Gastrointestinal disorders
  • Eating disorders

Related Codes for MNT Billing

  • CPT Code 97804: Used for group MNT sessions (2 or more individuals), billed in 30-minute units.
  • HCPCS Codes G0270 & G0271: Used by Medicare for MNT reassessment and intervention following a second referral in a calendar year (individual and group, respectively).
  • Modifiers: Sometimes required by payers to provide additional context (e.g., telehealth). Check specific payer guidelines (call them).

How to Bill CPT Codes 97802 & 97803

  • Claims are typically submitted using the CMS-1500 form (or electronic equivalent).
  • Enter the appropriate CPT code (97802 or 97803) in field 24D (“Procedures, Services, or Supplies”).
  • Crucially, specify the number of units based on the face-to-face time spent with the patient.
  • Include the relevant ICD-10 diagnosis code(s) justifying the medical necessity for MNT.

Documentation Requirements

Thorough documentation is crucial for reimbursement and compliance:

  • Record the date and exact time spent face-to-face.
  • Document the patient’s assessment details (history, dietary intake, nutritional status).
  • Clearly state the nutrition goals established.
  • Outline the intervention provided (counseling, education, plan adjustments).
  • Provide the patient with a written plan or guidelines summary.

Common Mistakes to Avoid

  • Using 97802 for Follow-Up Visits: Only use 97803 after the initial assessment.
  • Insufficient Documentation: Failing to record time accurately or provide detailed notes on the assessment, goals, and intervention.
  • Incorrect Units: Billing for an incorrect number of 15-minute units based on the time spent.
  • Not Verifying Coverage: Assuming coverage without checking specific payer policies and patient benefits.
  • Billing MNT and DSMT on Same Day: Medicare typically does not reimburse for both MNT and Diabetes Self-Management Training (DSMT) services provided on the same date.

License Level Requirements for Billing 97802 & 97803

  • Typically, services billed under 97802 and 97803 must be provided by a Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN). Some state regulations or payer policies might include other qualified nutrition professionals. Verify state and payer specific requirements.
  • Taxonomy Code: 133V00000X

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