How this gets paid
The reimbursement pathways that already exist for the care this tool supports, from primary federal sources. Codes are referenced by number; confirm specifics with your Medicare contractor and compliance office.
CPT 97802, 97803, 97804 and HCPCS G0270, G0271. The referral comes from the physician; the service belongs to the dietitian.
Diabetes, renal disease, or the 36 months after a kidney transplant.
“Chronic renal insufficiency means the stage of renal disease associated with a reduction in renal function not severe enough to require dialysis or transplantation (glomerular filtration rate [GFR] 15-59 ml/min/1.73m2).”
“Referral may only be made by a physician when the beneficiary has been diagnosed with diabetes or renal disease.”
“...only a registered dietitian or nutrition professional may provide the services.”
“During the initial calendar year, three hours of one-on-one MNT counseling are covered.” “Two hours each calendar year are covered during subsequent years.”
Additional hours are covered on a second referral in the same year when the physician documents a change in diagnosis, condition, or treatment (HCPCS G0270 individual, G0271 group). Beneficiary copayment, coinsurance, and deductible are waived.
MNT is paid under the Physician Fee Schedule and varies by locality and year. Look up current amounts rather than quoting a fixed figure.
Since the 2021 E/M changes, an office visit dominated by diet and lifestyle counseling can be leveled by the total time spent on the date of the encounter (CPT 99202-99215).
“Face-to-face behavioral counseling for obesity, 15 minutes” (G0447); group of 2 to 10, 30 minutes (G0473).
Medicare covers for BMI of 30 or more, furnished by a primary care practitioner in a primary care setting: weekly visits in month 1, every other week in months 2 to 6, then monthly through month 12 if at least 3 kg is lost by month 6. Up to 22 sessions in 12 months.
Time-based preventive counseling codes (about 15 to 60 minutes). Primarily paid by commercial and ACA plans; traditional Medicare generally does not pay them as standalone codes.
There is no dedicated SMA code. Each patient's individual face-to-face portion is billed as a standard E/M visit.
“Under existing CPT codes and Medicare rules, a physician could furnish a medically necessary face-to-face E/M visit (CPT code 99213 or similar code depending on level of complexity) to a patient that is observed by other patients.”
“Any activities of the group (including group counseling) should not impact the level of code reported for an individual patient.”
The Medical Nutrition Therapy Act (H.R. 6199; S. 3934, 119th Congress) would expand Medicare MNT beyond diabetes and renal disease to conditions including obesity, hypertension, dyslipidemia, cardiovascular disease, cancer, and GI disease, and let NPs and PAs refer. H.R. 6199
The Medicare GLP-1 Bridge runs July 1, 2026 through December 2027, and the CMS BALANCE model pairs Medicaid GLP-1 coverage with a required lifestyle-support program. Cited nutrition support alongside these drugs is exactly what this tool provides. CMS GLP-1 Bridge CMS BALANCE
CalAIM Community Supports reimburse medically tailored meals and medically supportive food through Medi-Cal managed care, with documentation requirements this tool can help generate. DHCS Community Supports
Informational summary for planning, not billing advice. Verify codes, coverage, and documentation requirements with your Medicare Administrative Contractor, payers, and compliance office. CPT codes are referenced by number only; CPT is a registered trademark of the American Medical Association, and descriptors are copyright AMA.