Medical nutrition therapy and diabetes self-management training coverage and billing requirements

August 21, 2026

This companion is for hospital outpatient and freestanding clinics who submit claims for medical nutrition therapy (MNT) and diabetes-management training (DSMT) services.

Background

Medicare benefits/ Guidelines	MNT	DSMT
Statute	Section 105 of the Benefits Improvement and Protection (BIPA) Act of 2000 permits Medicare coverage of MNT services when furnished by a registered dietitian or nutrition professional meeting certain requirements, effective January 1, 2002.	Section 4105 of the Balanced Budget Act (BBA) of 1997 permits Medicare coverage of the outpatient DSMT services when these services are furnished by a certified provider who meets certain quality standards, effective July 1, 1998.
Provider qualifications and requirements	RD or nutrition professional who meets the following criteria: Minimum of Bachelor of Science degree in nutrition or dietetics Completion of 900 hours of dietetics practice under supervision of RD or nutrition professional Licensed or certified as a dietitian or nutrition professional by state in which services are performed (federal employees can be licensed or certified in any state) Registered dietitian credential with the Commission on Dietetic Registration (CDR) is proof that education and experience requirements are met Grandfathered dietitian, nutritional professionals licensed or certified as of December 21, 2000	Program must be accredited as meeting approved quality standards, i.e., National standards for diabetes self-management education programs. CMS-approved national accreditation organizations include ADA, AADE and the Indian Health Service. Note: A diabetes education program cannot seek reimbursement from Medicare until the program has been accredited.
Qualifying diagnoses	Diabetes: Type 1 Type 2 Gestational Renal: Non-dialysis kidney disease Post-kidney transplants Diabetes is a condition of abnormal glucose metabolism diagnosed using the following criteria: FBS > 126 mg/dl on two different occasions Two-hour post-glucose challenge > 200 mg/dl on two different occasions; or, A random glucose test over 200 mg/dl for a person with symptoms of uncontrolled diabetes	Diabetes* Type 1 Type 2 Gestational Renal (must report as a secondary diagnosis to diabetes): Non-dialysis kidney disease Post-kidney transplants *Diabetes is a condition of abnormal glucose metabolism diagnosed using the following criteria: FBS > 126 mg/dl on two different occasions Two-hour post-glucose challenge > 200 mg/dl on two different occasions; or, A random glucose test over 200 mg/dl for a person with symptoms of uncontrolled diabetes
Limitations of coverage	No coverage for maintenance dialysis If beneficiary has diabetes and renal disease, the number of hours allowed is for diabetes or renal disease Only face-to-face time with patient DSMT and MNT services cannot be provided on the same date	No payment will be made for group sessions unattended (class attendance sheet) Only face-to-face time with patient DSMT and MNT services cannot be provided on the same date
Other conditions of coverage	The number of hours covered in a 12-month period (episode of care) cannot be exceeded Services can be provided on an individual or group basis	The training must meet the following conditions: Following an evaluation of the beneficiary’s need for training, the treating provider must order DSMT Be included in a comprehensive plan of care (POC) Be reasonable and necessary for treating or monitoring the beneficiary’s condition (signed statement of need) When training under a POC is changed, the treating provider must sign it In the initial DSMT benefit, nine of the 10 hours must be provided in a group setting (2–20 individuals) unless special conditions exist: No group class is available within two months of the date the training is ordered The beneficiary has special needs resulting in problems with hearing, vision or language limitations; or, The physician orders additional insulin training
Practice settings	Included: Hospital outpatient department, FQHC, RHC and freestanding clinics Excluded: Inpatient stay in hospital or skilled nursing facility	Included: Hospital outpatient department, freestanding clinic, FQHC and RHC Excluded: Inpatient hospital, skilled nursing facility, nursing home and hospice
Basic coverage	Initial MNT: During the initial calendar year, three hours of one-on-one MNT counseling are covered. Follow-up MNT: Two hours each calendar year are covered during subsequent years. Reassessment: Second referral (See CPT or HCPCS codes listed above) Hours can be spread over any number of visits during the year (One visit = 15 minutes) The number of hours can be increased if the treating physician determines there is a change in medical condition, diagnosis and/or treatment plan.	Initial DSMT: Ten hours per year in the first year (one-hour individual assessment or specialized training plus nine hours group classes). Continuous 12-month period – need not be on calendar-year basis. Follow-up DSMT: Two hours per calendar year in subsequent years (individual or group training) Hours can be spread over any number of visits during the year (One visit = 30 minutes)
DSMT benefit and MNT benefit	CMS considers DSMT and MNT complementary services. This means Medicare will cover both DSMT and MNT without decreasing either benefit as long as the referring physician determines that both are medically necessary.	CMS considers DSMT and MNT complementary services. This means Medicare will cover both DSMT and MNT without decreasing either benefit as long as the referring physician determines that both are medically necessary.
Referring (Licensed) providers	Treating physician – A treating physician means the primary care physician or specialist coordinating care for the beneficiary with diabetes or renal disease.	Physician or qualified non-physician practitioner treating the patient’s diabetes (nurse practitioner, clinical nurse specialist, physician assistant, nurse midwife, clinical psychologist and clinical social worker).
Provider referral	A referral may only be made by the treating physician when the patient has been diagnosed with diabetes or renal disease with documentation maintained by the referring physician in the patient’s medical record. Referral must be made for each episode of care as a result of a change in medical condition or diagnosis. The National Provider Identifier (NPI) of the referring physician must be on the CMS-1500 claim form.	Provider-written and signed referral for training containing diagnosis and a written comprehensive POC. The POC must describe the content, number of sessions, frequency and duration of the training as written by the provider treating the beneficiary’s diabetic condition.
Protocols or standards	RDs and nutritionists should use nationally recognized protocols such as the American Dietetic Association’s MNT Evidenced-Based Guides for Practice.	American Diabetes Association Recognition Program or AADE based on the National Standards for Diabetes Self-Management Education.

Key points / instruction / what you need to know

Medicare benefits and CMS coverage guidelines	MNT	DSMT
Billable to Medicare Part A? UB-04 Form (Facility fee)	Hospital outpatient – Yes, only if the nutritionists or registered dietitians reassign their benefits to the hospital; applicable bill types are 13X and 85X, revenue code 51X Provider-based clinic – Yes Federally Qualified Health Center (FQHC) - Yes Rural Health Clinic (RHC) – No Freestanding clinic – No	Hospital outpatient – Yes, bill type 13X and 85X, revenue code 51X; must have valid certification filed with Medicare enrollment Provider-based clinic – Yes FQHC – Yes RHC – No Freestanding clinic – No
Billable to Medicare Part B? CMS-1500 Form (Professional services fee)	Freestanding clinic – Yes, only if the nutritionists or registered dietitians reassign their benefits to the clinic Hospitals – No Provider-based clinic – No FQHC/RHC – No	Freestanding clinic – Yes; must have valid certification filed with Medicare enrollment Hospitals – No Provider-based clinic – No FQHC/RHC – No
Enrolling as Medicare provider	To enroll in Medicare Part B, complete Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I).	Must be enrolled as a Medicare Part B provider. Once diabetes education program recognition is received, a copy of the American Diabetes Association (ADA), American Association of Diabetes Educators (AADE) or National Diabetes Program (NDP) certificate must be submitted to Medicare.
Provider Identification Number (PIN)	Registered dietitian (RD) or nutrition professional must enroll in the Medicare program to become a recognized Medicare provider. Upon enrollment, the RD or nutrition professional will receive a confirmation letter.	N/A
Other CMS-855 Forms for enrollment	RD or nutrition professional will complete Medicare enrollment application - Physicians and Non-Physician Practitioners (CMS-855I), to reassign benefits back to employer.	N/A
Facility application? Form CMS-855B, Medicare enrollment application for Clinics/Group practices and certain other suppliers	Yes, if facility does not have one.	Yes, if facility does not have one.
CPT or HCPCS codes	97802 – Medical nutrition, indiv, in 97803 – Med nutrition, indiv, subseq 97804 – Medical nutrition, group Multiple units of the codes can be used based on medical necessity and the complexity of the MNT decision-making. G0270 – Medical nutrition, reassessment, individual, each 15 minutes G0271 – Medical nutrition, reassessment, group, each 30 minutes	G0108 – Diabetes outpatient self-mgmt training service, individual, per 30 minutes G0109 – Diabetes outpatient self-mgmt training services, group session (two or more), per 30 minutes
Payment	RD should establish a fee schedule (based on usual and customary MNT fees) for MNT services Allowed payment rates have been established under the physician’s fee schedule (RD, Outpatient Facilities) Payment will be 80 percent of the lesser of the actual charge or 85 percent of the amount determined under the physician fee schedule CMS applies a Geographical Adjustment Factor (GAF) to the MNT rates in regions of the country	Freestanding clinics – Medicare Part B fee schedule Deductible and coinsurance apply Hospital outpatient facilities – outpatient prospective payment system (OPPS)
Incident to	Does not apply to MNT	Does not apply to DSMT
Medicare Part B documentation requirements (*Recommendations to facilitate timely and accurate billing)	Patient name/medical record number Qualifying medical diagnosis Written provider referral Physician signature RD name and signature Date of service Time in, time out and total time (to calculate number of units) MNT CPT Code Individual or group encounter* Visit number with cumulative time spent with patient to date*	Patient name/medical record number Qualifying medical diagnosis indicating condition that requires training Written provider referral and signed statement of need on initial encounter Date of original referral on all subsequent visits* Physician signature Date of service Time in – Time out and total time (to calculate number of units) DSMT “G” codes Individual or group encounter* Visit number with cumulative time spent with patient to date*

References

MNT:

DSMT: