What is a CPTⓇ Code?
Current Procedural Terminology (CPT) codes are procedure codes that describe medical services provided by healthcare professionals. These five digit codes are used for reimbursement and reporting purposes. These codes are required when filing a claim with health insurance companies.
While there are over 10,000 CPT codes, dietitians generally use less than a dozen, with many dietitians never using more than two or three.
Why are CPT Codes Used?
The use of CPT codes provides a uniform shorthand, so that everyone from healthcare providers to insurance companies, can easily speak the same language. This keeps everything streamlined while improving accuracy and efficiency. Just like an ICD-10 code is used to describe the diagnose treated, a CPT code is used to describe the medical service provided.
Where does the CPT Code Go?
If billing on a CMS1500 form, the CPT code goes in box 24D. If you are providing a superbill to a patient, the CPT code should be included.
Nutrition Counseling CPT Codes
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.
CPT Code 97802
The description of CPT code 97802 is, “medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes.”
This code is a time based code and is billed for each 15-minute increment. So, if an initial appointment is 60 minutes long, it will be billed for 4 units. Rounding is allowed with this code and is done using the 8-minute rule.
CPT Code 97803
The description of CPT code 97803 is, “medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes.” This code is to be used when follow up MNT appointments are performed.
In other regards, this code is quite similar to 97802. It generally pays out less than 97802.
CPT Code 97804
CPT Code 97804 is the third MNT code and is described as, “medical nutrition therapy; group (2 or more individual(s)), each 30 minutes.” This code is to be used when performing group MNT sessions.
This is a time based code, but is based on 30-minute units, rather than 15-minute units.
Other Codes Dietitians May Use
Dietitians may use other codes beyond the MNT codes, but it is advised to proceed with caution. Make sure you understand what the code means, how it can be billed, and if it is part of your contract.
It can be tempting to bill for a service that pays out well, but it is important that providers bill correctly and with integrity. Speaking with your compliance and billing team, the payer, the Academy of Nutrition and Dietetics (AND) and/or a healthcare attorney is recommended if you are venturing beyond the MNT codes.
HCPCS Code G0270
G0270 is actually not a CPT code, but rather a Healthcare Common Procedure Coding System (HCPCS) code. Although CPT and HCPCS are technically different, they function the same and are put in the same place on the CMS1500 form.
The description of G0270 is, “Medical Nutrition Therapy; reassessment and subsequent intervention(s) following second referral in the 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.”
This code can be used to get additional follow up appointments beyond the general 3 hour and 2 hour limit that Medicare has. An additional referral is required.
HCPCS Code G0271
The description of G0271 is, “Medical Nutrition Therapy reassessment and subsequent intervention(s) following second referral in the 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.”
This code is similar to G0270 but is for group MNT, rather than individual.
HCPCS Code G0446
Code G0446 is used to bill Medicare for Intensive Behavior Therapy for cardiovascular disease and is defined as, “annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes.”
This benefit must be billed “incident to” a physician or other prescribing provider, so most dietitians in private practice are not rendering this service. However, if a dietitian has a relationship with a primary care office, billing for this service could be an option.
CMS Guidance on Billing Incident to a Physician’s Services
HCPCS Code G0447
The G0447 code is used to bill Medicare for Intensive Behavioral Therapy for obesity. It’s defined as, “individual; face-to-face behavioral counseling for obesity, 15 minutes.”
This service must also be billed incident to a physician or other prescribing provider.
HCPCS Code G0473
HCPCS Code G0473 is very similar to the G0447 code, but it is used for a group, rather than an individual. It is described as, “group; face-to-face behavioral counseling for obesity, 30 minutes.” Note that it is a 30-minute code, not a 15-minute code.
HCPCS Code S9470
HCPCS code S9470 is defined as, “nutritional counseling, dietitian visit,” and is the original nutrition counseling code as it existed before the MNT codes were introduced. Now that the MNT codes have been around, you may or may not see S9470 being covered by private payers. Medicare does not reimburse for this code.
HCPCS Code G0108
Code G0108 is defined as, “diabetes outpatient self-management training services, individual, per 30 minutes.” This benefit is intended to be used to educate patients on diabetes self-management; including topics such as blood sugar monitoring, diet, exercise and insulin regimens.
Only providers that are a part of accredited programs can bill Medicare for this service. Commercial and medicaid plans may not have this requirement, but it is important to clarify this before billing for the service.
G0108 is a time-based code with a unit of 30 minutes. CMS does not have specific guidance on rounding for this code, therefore, it is generally recommended not to round.
HCPCS Code G0109
HCPCS code G0109 is very similar to G0108, but it is used for groups. It is defined as, “diabetes outpatient self-management training services, group session (two persons or more), per 30 minutes.”
CPT Code 95249
CPT code 95249 is described as, “ambulatory continuous glucose monitoring of interstitial fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording.”
This code is used when training a patient on a continuous glucose monitor (CGM). A dietitian will need to bill incident to a physician when billing Medicare. Some plans may allow billing incident to an advanced practice provider as well, but a dietitian or other non-prescribing healthcare provider can never bill directly under their NPI for this code.
Per the American Medical Association’s CPT 2021 Professional edition, this code cannot be used more than once, unless the patient obtains a new and/or different model of data receiver.
CPT Code 95250
The description of CPT code 95250 is, “ambulatory continuous glucose monitoring of interstitial fluid via a subcutaneous sensor for a minimum of 72 hours; physician other other qualified healthcare professional (office) provided equipment, senor placement, hook-up, calibration of monitor, patient training, removal of senor, and printout of recording.”
This code is similar to CPT code 95249, but is used when a professional CGM, rather than a personal CGM, is provided. The same rules regarding billing incident to apply. This code can be billed once a month.
CPT Code 94690
CPT code 94690 is described as, “oxygen uptake, expired gas analysis; rest, indirect (separate procedure).” This is a pulmonary diagnostic testing and therapies code, but can potentially be billed when using indirect calorimetry, such as a MedGem, to measure resting metabolic rate. The device must be FDA approved for this code to be billed.
HCPCS Codes G0438 and G0439
Code G0438 is defined as, “annual well visit; includes a personalized prevention plan of services (PPPS), initial visit,” while code G0439 is, “annual well visit; includes a personalized prevention plan of services (PPPS), subsequent visit.”
Annual well visits are a Medicare benefit. They must be billed incident to the physician.
CPT Codes 98960 – 98962
CPT code 98960 is for, “education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient.”
Code 98961 is used when there are 2-4 patients, and 98962 is used when there are 5-8 patients.
CPT Codes 98966 – 98968
The description of CPT code 98966 is, “telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.”
CPT code 98967 is used when the medical discussion is 11-20 minutes long. CPT code 98968 is used when it is 21-30 minutes long.
CPT Codes 98970 – 98972
CPT code 98970 is described as, “qualified nonphysician healthcare professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes.”
This code is used when billing for 11-20 minutes and CPT code 98972 would be used when billing for 21 or more minutes.
CPT Codes 99366 and 99368
The description of CPT code 99366 is, “medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional.”
The description of CPT code 99368 is, “medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family not present, 30 minutes or more, participation by nonphysician qualified health care professional.”
CPT Codes 99401 – 99404 and 99411 – 99412
CPT code 99401 is described as, ”preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.”
The following CPT codes are used for longer counseling sessions:
- 99402: approximately 30 minutes
- 99403: approximately 45 minutes
- 99404: approximately 60 minutes
CPT code 99411 is used if this service is provided in a group setting and approximately 30 minutes long. CPT code 99412 is used for a group setting that is approximately 60 minutes long.
CPT Codes 99406 and 99407
CPT code 99406 is used for, “smoking tobacco use cessation counseling visit; intermediate; greater than 3 minutes up to 10 minutes.” CPT code 99407 is used when the counseling visit is, “intensive; greater than 10 minutes.”
CPT Codes 99487 and 99489
The description of CPT code 99487 is, “complex chronic care management services with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
- Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
- Moderate or high complexity medical decision making; first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.”
The description of CPT code 99489 is, “each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure).”
CPT code 99489 is to be reported in conjunction with 99487.
CPT Code 99490
The description of CPT code 99490 is as follows, “chronic care management services with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
- Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
- Comprehensive care plan established, implemented, revised, or monitored;
first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.”
Frequently Asked Questions
How Do I Know What Codes I Can Bill For?
Your contract with the health insurance company should list all the procedure codes you can bill with. Since every plan may have different coverage, it is also important for either the provider or the patient to check benefits for the specific plan as well.
Should I Copy What Codes Other Dietitians are Billing with if They are Getting Paid?
It can be tempting to bill for different codes, especially if you hear from a colleague or members of a dietitian Facebook group, that they are making good money off of them. However, I highly recommend using caution when straying from the MNT codes.
Make sure you truly understand what the code means and what is required to fulfill the definition. Get information from sources such as CMS, AND and the payers directly.
There is, unfortunately, a lot of misinformation spread between dietitians regarding coding and billing. Remember that dietitians are trained to be experts in food and nutrition, not in reimbursement. We need to do our due diligence to get information from credible sources to make sure we are doing things correctly.
Even if you are personally getting paid for different codes, realize that insurance companies can claw back money that has been previously paid out. Every state has different laws on how far out insurance companies can do this. You can also reference your contract for further information.
Are All CPT Codes Time Based?
Not all CPT and HCPCS codes are time based codes. For example, 97802 and 97803 are time based, but S9470 is not.
Most time based codes are based on a 15-minute increment, but some are based on other increments such as 30 minutes.
Final Thoughts
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.
References:
CPT Overview and Code Approval
RDN’s Complete Guide to Credentialing and Billing: The Private Payer Market
Power of Payment Video: Introduction to CPT Codes
Intensive Behavioral Therapy for Obesity: Putting It Into Practice
2022 Billing Codes & Reimbursement for Diabetes Technology Services