Insurance Coverage, Billing & Coding

Medicare covers medical nutrition therapy (MNT) provided by a dietitian for patients that have diabetes, non-dialysis kidney disease or have had a kidney transplant in the last 36 months. There is a limit to the number of visits and a referral is required. Additional hours of MNT are covered if medically necessary.

An ICD-10 code is a type of medical code used to represent diagnoses, symptoms and procedures. Dietitians need to use ICD-10 codes to bill insurance companies for nutrition counseling services. However, diagnosing medical conditions is not in a dietitian’s scope of practice, so using ICD-10 codes has to be done carefully.

Some CPTⓇ and HCPCS codes are billed based on the amount of time spent with the patient. When these timed, also known as time-based, codes are reported on the billing claim, the number of minutes is rounded to the nearest 15-minute increment using the 8-minute rule.

Coding modifiers add extra information about the procedure provided, without changing the inherent description of the procedure code. While there are dozens upon dozens of medical modifiers, dietitians do not need to be familiar with all of them. Modifiers dietitians should be familiar with include the ABN modifiers, telehealth modifiers and modifier 33.

Procedure code G0108 is defined as, “diabetes outpatient self-management training services, individual, per 30 minutes.” This code is used to bill for diabetes education that is provided one-to-one. Patients may be educated on topics such as Pathophysiology of diabetes, treatment options, coping strategies, nutrition, physical activity, blood sugar monitoring and behavior change strategies.

Current Procedural Terminology (CPT) codes are procedure codes that describe medical services provided by healthcare professionals. These codes are required for billing health insurance companies. The Medical Nutrition Therapy, or MNT, codes are the go-to codes for registered dietitians when providing nutrition counseling. They include CPT codes 97802, 97803 and 97804.

Current Procedural Terminology (CPT) codes describe medical services provided by healthcare professionals. The MNT codes, CPT 97802, 97803 and 97804 are the most common procedure codes used to bill for nutrition counseling. However, there are many other procedure codes that fall within a dietitian’s scope of practice as well.

The GY modifier is defined as, “item or service statutorily excluded or does not meet the definition of any Medicare benefit.” This modifier is to be used in certain situations when seeing a patient with Medicare. If billing on a CMS-1500 form, medical modifiers go in box 24D, next to the CPTⓇ code.

The GX modifier is defined as, “item or service expected to be denied as not reasonable and necessary.” This modifier is to be used in certain situations when seeing a patient with Medicare. If billing on a CMS-1500 form, medical modifiers go in box 24D, next to the CPTⓇ code.

The GZ modifier is defined as, “item or service expected to be denied as not reasonable and necessary.” This modifier is to be used in certain situations when seeing a patient with Medicare. If billing on a CMS-1500 form, medical modifiers go in box 24D, next to the CPTⓇ code.