Community First Health Plans is providing guidance on billing requirements for Medical Nutrition Therapy (MNT) services. Proper coding and diagnosis reporting supports accurate claims processing, CMS compliance, and reduces claim denials.
Medical Nutrition Therapy (MNT) Codes
Effective June 1, 2026, claims submitted with the following Medical Nutrition Therapy CPT and HCPCS codes will be denied if billed without a required diagnosis on the claim:
- 97802 – Initial assessment and intervention, individual, each 15 minutes
- 97803 – Reassessment and intervention, individual, each 15 minutes
- 97804 – Group intervention, each 30 minutes
- G0270 – Reassessment and subsequent intervention following a second referral in the same year due to a change in diagnosis, medical condition, or treatment regimen, individual, each 15 minutes
- G0271 – Reassessment and subsequent intervention following a second referral in the same year due to a change in diagnosis, medical condition, or treatment regimen, group, each 30 minutes
Covered Indications
Medical Nutrition Therapy services are covered only when billed with a diagnosis of:
- Medical Nutrition Therapy services are covered only when billed with a diagnosis of:
- Diabetes mellitus
- Renal disease
- Kidney transplantMNT services billed with all other diagnoses are not covered.
MNT services billed with all other diagnoses are not covered.
Limitations of Coverage
Medical Nutrition Therapy services are not separately payable for beneficiaries receiving maintenance dialysis. Monthly dialysis maintenance management codes 90951–90962 include MNT services. As a result, MNT is not payable during the same calendar month in which a dialysis maintenance service has been reimbursed.
- MNT services must be billed by a registered dietitian or qualified nutrition professional.
- CPT 97802 may be billed one time only for the initial assessment of a new patient.
- All subsequent visits must be billed using:
- 97803 for individual reassessments, or
- 97804 for group services.
- The CMS National Correct Coding Initiative (NCCI) allows only one MNT code per date of service.
- Modifiers may not be used to bypass NCCI code combinations.
Frequency of Services
- A total of 3 hours of Medical Nutrition Therapy is allowed during the initial year. Additional hours may be covered only when there is a documented:
- Change in medical condition
- Change in diagnosis
- Change in treatment regimen
Action:
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
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