Description of HCPCS Code G0270
The description of procedure code G0270 is “MNT; 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”.
Medicare Medical Nutrition Therapy Benefits
To understand HCPCS G0270, general Medicare Medical Nutrition Therapy (MNT) benefits need to be understood.
Medicare covers MNT for diabetes and chronic kidney disease. There is a limit of 3 hours for the first calendar year of nutrition counseling and 2 hours for every subsequent year. These visits are billed using CPTⓇ codes 97802 and 97803.
If additional hours of nutrition counseling are warranted, then the code G0270 will have to be used.
Requirement for Using HCPCS G0270
Additional hours of MNT, billed using G0270, are covered if medically necessary and ordered by a physician. A second referral from the physician must be obtained.
Documentation from Centers for Medicare & Medicaid Services (CMS) states that additional hours are medically necessary, “if the physician determines that there is a change in medical condition, diagnosis or treatment regimen related to diabetes or renal disease that requires a change in MNT and orders additional hours during that episode of care.”
Some dietitians interpret this information more liberally than others. If the patient is not understanding the education or is needing more information, personally, I feel that this does not meet the above requirement.
The fact that MNT is limited to 2 or 3 hours per year for Medicare patients is disappointing, however, it is what CMS has decided on.
How Many Hours or Units Are Covered by Medicare?
CMS does not have a specified limit for additional hours.
Can HCPCS G0270 Be Used for Group Nutrition Counseling?
No, HCPCS G0270 cannot be used for group nutrition counseling. In this situation, HCPCS G0271 would be used instead.
What is the Reimbursement for G0270?
HCPCS G0270 has the same reimbursement rate as the MNT code 97803. Medicare fee schedules are public information and can be found using the CMS look-up tool. Dietitians get paid 85% of the fee schedule rate.
Just like CPT codes 97802 and 97803, G0270 is considered a preventive benefit. This means that there is no patient responsibility as coinsurance and deductibles are waived.
Do Insurance Plans Other Than Medicare Cover G0270?
Original Medicare and Medicare Advantage Plans have coverage for G0270. Most commercial plans do not cover this code. Using G0270 is often not necessary with commercial plans as there may be an unlimited number of visits per year.
Summary of HCPCS G0270
Procedure code G0270 is a great way to get additional MNT benefits for patients that have a Medicare plan. There are specific situations for when the code should be used, and an additional referral is required.