Step-by-Step Guide to Medicare

Medical Nutrition Therapy (MNT) 

Reimbursement

2nd Edition, April 2010 

Indian Health Service

Division of Diabetes Treatment and Prevention

Albuquerque, New Mexico

www.diabetes.ihs.gov
Step-by-Step Guide to Medicare 

Medical Nutrition Therapy (MNT) 

Reimbursement

2nd Edition, April 2010 

Writing Team

CAPT Tammy L. Brown, MPH, RD, BC-ADM, CDE

Cecilia Butler, MS, RD, CDE

LCDR Susan Jones, MS, RD, LD, CNSD

CDR Sandra Lahi, MBA, RHIA, CPC

LCDR Diane Phillips, RD, LD, CDE

CDR Leslye Rauth, MPH, RD, CDE

Jimmie Strock, MS, RD, 

Sara Lee Thomas, MS, RD

CAPT Leeanna Travis, MS, MA, RD, CDE

Indian Health Service

Division of Diabetes Treatment and Prevention

Albuquerque, New Mexico

www.diabetes.ihs.gov
Table of Contents

Foreword..............................................................................................................................v

Introduction........................................................................................................................vi

Frequently Used Abbreviations.......................................................................................vii

SECTION ONE: Ready...Set...Medical Nutrition Therapy

An Overview of Medicare Medical Nutrition Therapy Reimbursement.......................8

The Medical Nutrition Therapy Medicare Benefit ............................................................9

Qualifying Diagnoses for Reimbursement ....................................................................12

SECTION TWO: Let’s Get Started...Go! 7 Steps for Medicare Medical Nutrition Therapy 

Reimbursement................................................................................................................ 14

Step 1: Become a Recognized Medicare Provider ........................................................15

Step 2: Make Friends with Your Business Office..........................................................17

Step 3: Obtain Treating Physician Referral and Authorization for Patient Visits ..............19

Step 4: Learn More about Procedural (CPT) Codes and Diagnosis (ICD-9) Codes for 

Reimbursement ........................................................................................................21

Step 5: Document MNT Services ...............................................................................25

Step 6: Track MNT Services and Reimbursement ........................................................30

Step 7: Market MNT Services ....................................................................................33

Flow Chart of Steps for MNT Reimbursement...............................................................36

SECTION THREE: Resource Materials........................................................................... 37

Appendix A: Summary Chart on IHS Medicare Part A and B Coverage and Billing 

Requirements for MNT and DSMT...............................................................................38

Appendix B: Sample Forms ........................................................................................46

1. IHS MNT Referral Form (Electronic Version)........................................................46

2. IHS MNT Patient Referral IHS Form 199-1 ..........................................................49

3. MNT Superbill – Electronic Health Record Version................................................50

4. MNT Superbill with Telehealth Modifier...............................................................51
5. Third Party Reimbursement Tracking Form and Instructions .................................52

6. CMS Form 1500 (Health Insurance Claim Form) ..................................................54

7. Diabetes Services Order Form (DSMT and MNT Services).....................................55

8. PCC Ambulatory Encounter Record.....................................................................56

9. RPMS Billing Report ..........................................................................................57

Appendix C: Indian Health Case Study Using Electronic Health Record (EHR) and 

Nutrition Practice Guidelines via the Nutrition Care Process...........................................58

1. Initial Visit........................................................................................................59

2. Follow-up Visit..................................................................................................62

Appendix D: .............................................................................................................64

1. Initial Visit........................................................................................................64

2. Follow-up Visit..................................................................................................65

Appendix E: Nutrition Care Process and Model.............................................................66

Appendix F: Additional Resources ...............................................................................68

1. IHS Medical Nutrition Therapy Action Team ........................................................68

2. Invest in Nutrition Flyer.....................................................................................70

3. American Dietetic Association (ADA) Evidence-Based Guidelines ...........................71

4. ADA Website MNT Reimbursement Page.............................................................71

5. ADA Nutrition Care Process and Terminology ......................................................71

6. CMS Website Medicare Learning Network ...........................................................72

7. IHS Division of Diabetes Treatment and Prevention Diabetes Best Practices...........72

8. IHS Division of Diabetes Treatment and Prevention Clinical Guidelines Resources...73

9. Other Organizations, Programs, and Resources. ..................................................73

Appendix G: Glossary ................................................................................................74

Appendix H: References ............................................................................................79

Acknowledgements ......................................................................................................... 81
Foreword

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition v

Foreword

Research shows that medical nutrition therapy (MNT) reduces illnesses and improves quality of 

life for people with chronic diseases. That is why, in 2002, Congress 

authorized the MNT benefit for Medicare beneficiaries with diabetes and 

certain stages of kidney disease. Since then, many insurance programs 

offer reimbursements to registered dietitians (RDs) and other qualified 

nutrition professionals providing MNT services. MNT is effective for 

patients and increases their access to quality care—a priority for the 

Indian Health Service (IHS). At the same time, reimbursement for this 

care also presents a new revenue stream for the Indian health care 

system.

This edition of the Step-by-Step Guide to Medicare MNT 

Reimbursement, an update of the 2006 publication. It provides IHS, Tribal, and Urban health 

program staff, especially registered dietitians, with all the information they need for prompt 

Medicare reimbursement. The guide clearly and concisely illustrates seven steps—from 

becoming a Medicare-recognized provider to marketing MNT services—and includes useful 

resources for putting these steps into practice. This edition also contains an update on MNT 

telehealth reimbursement, a sample electronic MNT superbill, and case studies showing how to 

use the IHS electronic health record (EHR) and international dietetics and nutrition 

terminology.

I encourage health care professionals to use the information provided here to minimize 

administrative inefficiency and maximize reimbursements. Your comments about using this 

guide are welcome and may be directed to the IHS Medical Nutrition Therapy Action Team 

(MAT), at IHSMNTActionTeam@ihs.gov. I also want to thank IHS, Tribal, and Urban health 

program staff; CMS personnel; and American Dietetic Association employees, for their 

important contributions to this useful publication. 

/s/

Yvette Roubideaux, M.D., M.P.H.

Director, Indian Health Service 
Introduction 

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition vi

Introduction

“At Phoenix Service Unit, we were on track in FY 

2009 to nearly double our reimbursement for 

MNT. I think the single thing that has helped 

with this increase is using the national MNT 

template for the electronic health record. We can 

document ICD9, CPT, and time for each 

encounter. The MNT template is accurate, legible, 

and standardized.”

CAPT Edith Clark, Director, Nutrition Services and 

Director, IHS Southwestern Dietetic Internship 

Consortium, Phoenix Indian Medical Center, Phoenix, AZ

Overview of the Step-by-Step Guide to MNT Medicare Reimbursement

The step-by-step guide to MNT Medicare Reimbursement is designed primarily for Indian 

health care system registered dietitians (RDs). The purpose of the guide is to help you learn 

how to:

• Document MNT services and outcomes 

• Work with your health care facility to bill for MNT services 

• Take an active role in seeking MNT reimbursement and 

• Market your services within the Indian health care system and to your Tribal members. 

The guide is divided into three sections:

MNT Reimbursement Overview

This section introduces you to Medicare MNT reimbursement and the qualifying diagnoses for 

reimbursement. 

The 7 Steps to MNT Reimbursement 

This section takes you, step-by-step, through the MNT reimbursement process. 

Resource Materials

In these appendices, you will find many helpful resources related to MNT reimbursement, 

including sample forms, case studies, guidelines, resources and people to contact for help, a 

glossary, and references.

Many Indian health dietitians shared tips and ideas to create this comprehensive, step-by-step 

guide. They and others have found that MNT works, saves money, and makes money. 

Opportunities to be reimbursed for your services are waiting for you. Take advantage of 

them! Embrace them! Just do it!

Dietetic Intern Cheyenne Isaacs and 

CAPT Edith Clark
Frequently Used Abbreviations 

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition vii

Frequently Used Abbreviations

AADE...........................................................................American Association of Diabetes Educators

AI/AN.........................................................................................American Indian and Alaska Native

CDE........................................................................................................Certified Diabetes Educator

CMS..............................................................................Centers for Medicare and Medicaid Services

CPT........................................current procedural terminology or common procedural terminology

DSMT.......................................................................................diabetes self-management training*

EHR..............................................................................................................electronic health record

FQHC.............................................................................................federally qualified health centers

ICD-9...............................................................International Classification of Diseases, 9th Revision

IDNT...................................................................International Dietetics and Nutrition Terminology

IHS.....................................................................................................................Indian Health Service

MNT...........................................................................................................medical nutrition therapy

NCP.................................................................................................................nutrition care process

NCPM......................................................................................................nutrition care process model

NPI.............................................................................................................national provider identifier

PCC................................................................................................................patient care component

PFE.......................................................................................patient and family education protocols

RD.........................................................................................................................Registered Dietitian

RPMS............................................................................Resource and Patient Management System

* DSMT is also known as DSME, or diabetes self-management education. Although DSME is the 

preferred term, the CMS requires the use of DSMT in reimbursement documentation. 

Therefore, “DSMT” is used throughout this guide.
SECTION ONE

(L to R): Community Dietitian Sandra Poitra providing MNT to 

Darlene LaVallie, IHS Turtle Mountain Comprehensive Healthcare 

Center, Belcourt, ND 

Ready...Set...Medical Nutrition Therapy

An Overview of Medicare

Medical Nutrition Therapy Reimbursement
The Medical Nutrition Therapy Medicare Benefit

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 9

The Medical Nutrition Therapy Medicare Benefit

“Working at CMS opened my eyes to how many resources are 

available for dietitians. Now I know how to apply for 

reimbursement for our hospital and there are educational 

opportunities for my clients I never knew existed. Don't miss out on 

this great opportunity for you, your hospital, and your patients!"

LCDR Susan Jones, Senior Clinical Dietitian

IHS Northern Navajo Medical Center, Shiprock, NM 

What is the Medicare Part B MNT benefit?

In January 2002, the Centers for Medicare and Medicaid Services (CMS) established the medical 

nutrition therapy (MNT) benefit to help lower the nation’s health care costs. Providing 

reimbursement for MNT to certain groups of Medicare beneficiaries recognized the importance 

of this service in disease management and health improvement.

MNT became a distinct Medicare benefit under Section 105 of the Medicare, Medicaid, and 

SCHIP Benefits Improvement Protection Act (BIPA). Eligible Medicare Part B beneficiaries with 

diabetes or non-dialysis kidney disease or who are post-kidney transplant are covered for MNT 

services provided by a registered dietitian (RD) or a nutrition professional who meets 

Medicare’s requirements. These qualified professionals can be reimbursed by Medicare for 

their MNT services. A treating physician must make the referral for MNT. (See “Step 1: Become 

a Recognized Medicare Provider.”)

At time of publication, health care providers who are not RDs or nutrition professionals do not

qualify for Medicare MNT reimbursement. In addition, non-physician practitioners (e.g., nurse 

practitioners or physician assistants) cannot make MNT referrals that qualify for Medicare 

reimbursement. 

In January 2006, the CMS added individual MNT to the list of Medicare telehealth services 

eligible for reimbursement. In January 2011, the CMS added group MNT to reimbursementeligible services. Providing MNT via telehealth services to patients in rural and underserved 

areas has enhanced and expanded nutrition services in American Indian and Alaska Native 

communities.

Regulations for MNT can be found in 42 CFR 410.130-410.134) on the 

Internet at: http://www.cms.hhs.gov/transmittals/downloads/R154CIM.pdf.
The Medical Nutrition Therapy Medicare Benefit

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 10

What are the criteria for reimbursement of MNT Telehealth?

MNT telehealth covers services provided to an individual or group. An interactive audio and 

video telecommunications system must be used permitting real-time communication between 

the distant site practitioner and the Medicare beneficiary. As a condition for payment, the 

patient must be present and participating in the telehealth visit. The only exception to the 

interactive telecommunications requirement is in the case of Federal telemedicine 

demonstration programs conducted in Alaska or Hawaii. In this case, Medicare payment is 

permitted for telehealth services when asynchronous store and forward technology is used.

Reaching Remote Rural Patients through Telehealth

LCDR Diane Phillips, Program Director of the 

IHS Telenutrition Program in Flagstaff, AZ, is 

one of the first IHS registered dietitians to 

venture into the telehealth arena. Since 

November 2006, LCDR Phillips has used 

telehealth to deliver real-time MNT services 

through video conferencing to the Crow 

Service Unit (Crow, MT) and the Elko Service 

Unit (Elko, NV). Since then, she has expanded 

her services to the Hopi Health Care Center 

(Paolacca, AZ) and the Supai clinic in a remote 

village on the floor of the Grand Canyon 

(Havasupai, AZ). This integration of technology with MNT improves patient selfcare management and facilitates continuous, uninterrupted nutrition service in rural 

health professional shortage areas.

What does the MNT Medicare benefit include?

The MNT Medicare benefit includes:

• 3 hours of initial MNT in the first calendar year (January – December). 

• 2 hours of follow-up MNT in subsequent calendar years.

Additional hours of MNT can be provided and reimbursed when the treating physician 

determines a change in medical condition, diagnosis, or treatment plan that makes additional 

MNT necessary. The treating physician must provide a new referral. In addition, the treating

physician must provide a referral for the 2 hours of follow-up MNT.

Here are additional rules to keep in mind regarding the MNT Medicare benefit as listed on the 

CMS website: http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part3.pdf.

The treating physician must provide a referral for MNT, follow-up MNT, or for 

change in the patient’s treatment plan.
The Medical Nutrition Therapy Medicare Benefit

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 11

• The number of hours of MNT can be spread out over any number of sessions during the 

calendar year (Minimum length of one visit = 15 minutes). 

• The 3 hours of MNT start whenever the treatment changes.

• The number of MNT hours cannot be carried over to the next calendar year. For

example, a treating physician gives a referral to the beneficiary (your patient) for 3 hours 

of MNT and the beneficiary uses only 2 hours during the calendar year. The unused 3rd

hour cannot be carried over into the following calendar year, but the beneficiary is 

eligible for 2 follow-up MNT hours (with a new referral from the treating physician). 

• MNT services can be provided on an individual or group basis. MNT services for 

individuals are billed in units of 15 minutes; MNT services for groups are billed in units of 

30 minutes. MNT telehealth only covers individual nutrition counseling.

• Every calendar year, the beneficiary must obtain a new referral from the treating 

physician for follow-up MNT hours. 

What is the Medicare MNT payment rate?

The Indian Health Service (IHS) All-Inclusive Rate is the rate negotiated by the IHS for services 

provided under Medicare Part A. As of February 2010, the outpatient IHS All-Inclusive Rate 

was $230 for a single day of patient care (including care and services beyond MNT) for all 

states except Alaska. In Alaska, the rate was $407. The IHS renegotiates this rate with the 

Office of Management and Budget (OMB) each year, so the rate may vary from year to year. 

Your billing office will have information about current rates. 

Payment for MNT services under Medicare Part B follows the physician fee schedule payment 

rate. The Medicare Part B MNT payment will be 80% (because a 20% patient co-pay applies) or 

the lesser of either the actual charge or 80% of the physician fee schedule amount. 

The physician fee schedule varies by state. For example, in New Mexico, the physician fee 

schedule payment rate is $65/hour (or $16.25/15-minute unit). Check with your billing office 

about the current IHS physician fee schedules for your state.

A RD or nutrition professional who becomes a Medicare provider must accept the approved 

payment amount for MNT services provided to Medicare beneficiaries. In Medicare language, 

this is called “accepting assignment.” Please note that the RD does not receive payment 

directly. Instead, payment is sent to the clinic or facility.

What about payment for MNT from other health insurance plans? 

Although this document focuses on Medicare reimbursement, you can seek reimbursement for 

MNT services from other payers. Many private insurance plans, health maintenance 

organizations, or preferred provider organizations will pay for MNT services. Also, find out if 

your state Medicaid Program reimburses MNT services. 

 

Every state dietetic association has a reimbursement “expert.” Seek their advice.
Qualifying Diagnoses for Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 12

Qualifying Diagnoses for Reimbursement

The CMS reimburses MNT services for Medicare Part B beneficiaries who have a diagnosis of 

diabetes, non-dialysis kidney disease, or post-kidney transplant. 

Diabetes: Type 1 and Type 2

The patient must meet one of the following diagnostic criteria for diabetes:

• Fasting glucose > 126 mg/dl on two different occasions

• 2-hour post glucose challenge > 200 mg/dl on two different occasions

• Random glucose test > 200 mg/dl for a person with symptoms of uncontrolled diabetes

Currently, Medicare does not reimburse MNT services provided for patients with a primary 

diagnosis of pre-diabetes, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT). 

Medicare does, however, provide coverage for diabetes screening tests for eligible 

beneficiaries.

Kidney: Non-dialysis Kidney Disease and Post-kidney Transplantation

Medicare will reimburse MNT services for patients with non-dialysis kidney disease who meet 

these criteria:

• The patient has chronic renal insufficiency (i.e., reduction in kidney function that is not 

severe enough to require dialysis or transplantation; Glomerular Filtration Rate (GFR) 13–

50 ml/min/1.73m2

). 

• The patient has end stage kidney disease, but is not on dialysis (i.e., non-dialysis kidney 

disease).

• The patient has had a kidney transplant (and is eligible for MNT up to 6 months after the 

transplant).

Practice settings covered for MNT reimbursement

Medicare coverage of MNT services applies in a variety of settings, including hospital 

outpatient departments, freestanding clinics, physician offices, and home health settings. 

Federally Qualified Health Centers (FQHCs) also can bill MNT (and DSMT) as a separate service. 

MNT services provided through a rural health clinic (RHC) are not a separately billed service. 

Instead, MNT services at RHCs are billed as part of the IHS All-Inclusive Rate for Medicare Part 

A. 

Telehealth services through interactive audio and video telecommunications in real-time for 

beneficiaries (patients) who are from an originating site located in Health Professional 

Shortage Areas (HPSAs) not classified as Metropolitan Statistical Areas (MSAs) may substitute 

for a face-to-face, “hands on” encounter for individual and group MNT consultation. 

Medicare reimbursement for MNT will not be made if the beneficiary is a hospital inpatient or 

is in a skilled nursing facility, nursing home, hospice, or end stage kidney disease dialysis 

facility. 
Qualifying Diagnoses for Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 13

Limitations of Medicare coverage

There are several limitations to Medicare coverage for MNT reimbursement to remember:

• MNT services are not covered for individuals receiving dialysis. Payment is made only for 

post-kidney transplant patients. 

• If the beneficiary has diabetes and kidney disease, the number of hours allowed is either 

for diabetes or kidney disease. 

• Only face-to-face time with the patient is covered (see exception regarding telehealth 

services described above under practice settings). 

• To apply for reimbursement for MNT and diabetes self-management training (DSMT), 

these services cannot be provided on the same day.

Remember these Points:

• Calendar Year One: 3 hours of MNT 

max; no “rollover”

• Bonus Time: 2nd referral (use G 

codes)

• The key to additional hours is a 

change in treatment plan.

• The 3 hours start again when the 

treatment changes.
SECTION TWO

Let’s Get Started...Go!

7 Steps for Medicare

Medical Nutrition Therapy Reimbursement

(L to R): Roy Smith (patient) with CDR Carol Treat, 

Alaska Area Nutrition Consultant, Alaska Native 

Diabetes Program, Anchorage, AK 
Step 1: Become a Recognized Medicare Provider

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 15

Step 1: Become a Recognized Medicare Provider

“Becoming recognized Medicare providers has 

enhanced our profession and increased my referrals.”

Cecilia Butler, Clinical Dietitian and Diabetes Program 

Coordinator, IHS Santa Fe Hospital, Santa Fe, NM

Becoming a recognized Medicare provider requires two key steps: you need to meet certain 

criteria as a RD or a nutrition professional and then you need to complete and submit the 

necessary paperwork. If you need help, ask your business office staff if they can work with 

you to complete the application process.

What are the criteria for applying to become a recognized Medicare provider?

You must meet the following criteria to apply to become a recognized Medicare provider: 

• Bachelor degree or advanced degree in nutrition or dietetics from a regionally accredited 

college or university

• Completion of at least 900 hours of supervised dietetics practice under the supervision of 

a RD

• License or certification as a RD or nutrition professional by the state in which the services 

are provided. (If you practice in a state that does not provide licensure or certification, 

you can meet this requirement if the Commission on Dietetic Registration recognizes you 

as a RD, or if you meet the first two criteria above.) This requirement applies to RDs 

employed or contracted by IHS, Tribal, or urban Indian health systems. 

• For Federal employees, if you are a licensed RD and hold a license from a state different 

from the one in which you work, you can continue to hold any state license for which you 

have already been accepted. For telehealth MNT coverage, RDs have to be licensed in 

the same state where the beneficiary (patient) resides.

• RD credential with the Commission on Dietetic Registration. This credential provides 

proof that education and experience requirements have been met.

• Grandfathered dietitians or nutrition professionals’ license or certification as of December 

21, 2000, if applicable.

(L to R): Cecilia Butler 

counseling a patient 
Step 1: Become a Recognized Medicare Provider

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 16

How do I become a recognized Medicare provider?

You will need to complete the following forms and paperwork to become a recognized 

Medicare provider.

National Provider Identifier Application

The first step in becoming a recognized Medicare provider is to obtain a National Provider 

Identifier (NPI), a 10-digit number assigned to every provider. NPI is a unique identifier for 

health care providers required by the Health Insurance Portability and Accountability Act 

(HIPAA) Administrative Standard. All health care providers need a NPI for billing purposes. 

For additional information on completing a NPI application, visit the person in your health 

facility who submits these forms for physicians. 

The estimated time to complete the NPI application form is 20 minutes. You can apply for a 

NPI online from the National Plan and Provider Enumeration System (NPPES) contractor at: 

https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions

1. CMS Form 855I Enrollment Application

In addition to obtaining a NPI, you will need to complete CMS Form 855I “Medicare 

Enrollment Application—Physicians and Non-Physician Practitioners.” You can access the 

form online at: http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf. Along with 

Form 855I, you will need to submit supporting documentation, such as your RD registration 

number and a copy of your state license or certification.

2. CMS Form 855R

You may need to complete other forms depending on your practice setting and employment 

relationship. For example, you may need to complete CMS Form 855R “Medicare Federal 

Care Reassignment of Benefits Application” to reassign Medicare payment back to the health 

care facility in which you provide services. This form is needed when you are employed or 

contracted by a facility that will submit the MNT service claims on your behalf and collect 

payment for your services. CMS Form 855R is available online at: 

http://www.cms.hhs.gov/cmsforms/downloads/cms855r.pdf.
Step 2: Make Friends with Your Business Office

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 17

Step 2: Make Friends with Your Business Office

“Working closely with the Business Office, we 

established a relationship that significantly 

enhanced our efforts to bill successfully for 

MNT and to capture the data to track 

reimbursements. Everyone felt a sense of 

ownership in this.”

Jimmie Strock, Supervisory Dietitian (Retired)

IHS Sells Service Unit, Sells, AZ

Just as you nurture your relationship with your health care team, you need to foster a 

cooperative relationship with your business office team. This may include the billing 

department, compliance officer, finance staff, and medical records coding department.

What should I do to develop a relationship with the business office?

The following steps can help ensure that you form a good working relationship with your 

business office:

• Introduce yourself to the business office team and meet the billing and coding staff.

• Ask permission to observe their process of entering health care visit data (often called 

data entry). 

• Ask for tips from the business office, data entry, and medical records staff members on 

how to document properly the information they need to submit claims.

• Ask, “What can I do to make business office processes easier?”

• Inform billing staff and coders about the MNT CPT codes to ensure that these are in 

RPMS. (See “Step 4: Learn More about CPT and ICD-9 Codes for Reimbursement.”)

• Adopt, adapt, or develop your own MNT referral form. (See Appendix B for sample IHS 

MNT Referral Forms.)

• Adopt, adapt, or develop your own “MNT superbill.” This pre-printed form itemizes and 

describes all services and fees to facilitate accurate coding and billing of services. (See 

“Step 5: Document MNT Services” and Appendix B for sample MNT Superbill Electronic 

Health Record Version and MNT Superbill with Telehealth Modifier.)

• Work with the billing and information systems staff to track claims and reimbursements 

and request a quarterly report. (See Appendix B for a sample Third Party Reimbursement 

Tracking Form and Instructions.)

(L to R): Priscilla Juan, Lauren Folson, and 

Mary Lingruen, MNT Billing and 

Reimbursement Team, and Jimmie Strock, 

IHS Sells Service Unit
Step 2: Make Friends with Your Business Office

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 18

• Get to know CMS Form 1500 “Health Insurance Claim Form.” Although as a RD 

you will not fill out this form, you need to be familiar with the data fields that will be filled 

in by the billing staff. Depending on your business office’s procedures, the business 

office staff either will file CMS Form 1500 electronically or submit it on paper to request 

reimbursement. (See Appendix B for a sample CMS Form 1500 and page 32 for a list of 

the Top Ten Documentation Errors to Avoid.)
Step 3: Obtain Treating Physician Referral and Authorization for Patient Visits

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 19

Step 3: Obtain Treating Physician Referral and 

Authorization for Patient Visits

“Physician referrals are key to the MNT reimbursement 

process.”

LT Kelli Wilson, Public Health Nutritionist, IHS Wewoka

Service Unit, Wewoka, OK

To obtain reimbursement for MNT services, a treating physician must provide a written 

referral before the RD provides MNT services. Physician assistants and nurse practitioners do

not qualify as referring providers under the Medicare statute concerning MNT.

What are the requirements for the treating physician referral? 

The treating physician must make the referral for MNT benefits for eligible Medicare patients 

who have a diagnosis of diabetes or renal disease or who are within 6 months post-kidney 

transplant. The physician’s referral is required for: 

• each episode of care during the calendar year 

• for additional MNT hours if needed in the same calendar year because the treating 

physician determines a change in medical condition, diagnosis, or treatment plan that 

results in a change in the diet plan and 

• for follow-up MNT in subsequent calendar years 

The treating physician’s MNT referral must provide the following information: 

• Documentation that MNT services are a necessary and appropriate medical service 

• Date of referral 

• Written treating physician order for MNT services and

• Treating physician’s signature.

Include the MNT referral and documentation of all MNT services provided in the patient’s 

medical chart. (See Appendix B for a sample IHS MNT Referral Form and a Diabetes Services 

Order Form (DSMT and MNT Services). See Appendix C for a sample EHR Nutrition Care Process 

MNT Note in the case study). 

(L to R) LT Kelli Wilson with 

Ronald Fried, Chief Medical 

Officer, IHS Wewoka Service 

i 
Step 3: Obtain Treating Physician Referral and Authorization for Patient Visits

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 20

When using the EHR, the referring physician should use the consult tab as the referral 

mechanism. The RD is responsible for generating a note in the consult tab under “Action” and 

then click on “Results” to inform the referring physician that the referral has been received. 

This ties the nutrition consult to the referral.
Step 4: Learn More about Procedural (CPT) Codes and Diagnosis (ICD-9) Codes for Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 21

Step 4: Learn More about Procedural (CPT) Codes and 

Diagnosis (ICD-9) Codes for Reimbursement

“Every provider must understand that accurate 

ICD-9 and CPT coding is necessary not only for 

the facility’s clinical statistics, but also for 

reimbursement purposes. Documentation is 

critical to support the accuracy of this coding.”

CDR Sandra Lahi, Business Office Coordinator 

(Acting), Oklahoma City Area Indian Health Service, 

Oklahoma City, OK

To document and secure reimbursement successfully for MNT services, you will need to 

become familiar with procedural (CPT) and diagnosis (ICD-9) codes used by the CMS. See 

Table 1 for a list of the codes, brief descriptions, and the time units for billing.

Table 1. MNT CPT Codes, HCPCS (G) Codes, and Telehealth Modifier

MNT CPT Code Description Time Unit

97802

Initial, individual MNT visit:

 Initial assessment and intervention visit

 Individual, face-to-face visit with patient

1 unit = 15 minutes

97803

Follow-up, individual MNT visit:

 Subsequent visit

 Individual, face-to-face visit with patient 

(Reassessment and intervention)

1 unit = 15 minutes

97804 Group MNT visit with two or more individuals 1 unit = 30 minutes

MNT G Code Description Time Unit

G0270

Individual MNT visit:

 Reassessment and subsequent intervention(s) 

following the second referral in the same calendar 

year for a change in diagnosis, medical condition, or 

treatment regimen (including additional hours needed 

for kidney disease)

 Individual, face-to-face visit with the patient

1 unit = 15 minutes

G0271

Group MNT visit:

 Reassessment and subsequent intervention(s) 

following the second referral in the same calendar 

year for a change in diagnosis, medical condition, or 

treatment regimen (including additional hours needed 

for kidney disease)

 Group visit with two or more patients

1 unit = 30 minutes

Telehealth Modifier Description Time Unit

GT

Via interactive audio and video telecommunications system 

real-time technology through the use of video conferencing 

equipment

1 unit = 15 minutes
Step 4: Learn More about Procedural (CPT) Codes and Diagnosis (ICD-9) Codes for Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 22

GQ Via asynchronous telecommunications system

store and forward technology 1 unit = 15 minutes

What are the CPT codes for MNT services? 

Providers use CPT or “Current Procedural Terminology” codes to describe the procedures that 

were performed during the patient visit. 

The MNT CPT codes are unique codes that describe MNT services provided by nutrition 

professionals. The CMS requires that you use these codes when documenting MNT services for 

Medicare reimbursement. 

As shown in Table 1: 

The MNT CPT codes are time unit-based. As a MNT provider, you can bill for multiple time 

units (e.g., a one hour, individual session = 4 time units) based on the medical complexity of 

the patient. You only can bill for the face-to-face time you have with the patient. This means 

that you cannot bill for preparation time or post-session documentation time. 

The IHS recommends that you document exact patient 

encounter start time and end time. The billing office will 

translate the start time and end time of the visit into 

appropriate time units when submitting a patient claim.

What are the MNT HCPCS or G codes?

The CMS established two additional Healthcare Common Procedure Coding System (HCPCS) 

codes for MNT, called G codes. The G codes should be used when additional hours of MNT 

services are performed beyond the number of hours typically covered in the calendar year. 

This can occur when the treating physician issues an additional referral during the same 

calendar year and determines a change of diagnosis or a medical condition that makes a 

change in diet necessary. The CMS has not set a specific limit on the number of these 

additional hours. 

 Use code 97802 for an individual patient’s initial assessment and 

intervention visits (up to 3 hours in the calendar year).

 Use code 97803 for a patient’s follow-up visits (up to 2 hours).

 Use code 97804 for group visits with two or more individuals (up to 3 

hours for each patient for the initial calendar year).
Step 4: Learn More about Procedural (CPT) Codes and Diagnosis (ICD-9) Codes for Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 23

As shown in Table 1: 

What are the Telehealth modifiers (codes)?

Effective January 1, 2006, the CMS established use of the Telehealth modifiers “GT” (via 

interactive audio and video telecommunications system) and “GQ” (via asynchronous 

telecommunications system). The interactive audio and video telecommunications system is 

through the use of a video conferencing unit conducted in real-time. Asynchronous 

telecommunications system utilizes the store and forward technology. 

As shown in Table 1: 

What are the ICD-9 codes for MNT services? 

ICD-9 codes, or codes from the International Classification of Diseases, 2009 Revision, Clinical 

Modifications, are used to describe diagnoses and are updated annually. ICD-9 codes covered 

in the Medicare Part B MNT benefit are listed in the following sections of the code book:

• 250.00: Series codes for diabetes

• 585.00: Series codes for chronic kidney failure

• V42.0: Series codes for kidney transplant

You will need to obtain the correct diagnosis from the patient’s treating physician. Once the 

medical provider documents the diagnosis code, the coding staff will assign the specific code 

into the system.

RDs or nutrition professionals cannot determine the medical diagnosis. This is beyond the 

scope of your practice. (Please refer to Franz et al, 2008, in the References for more 

information on the standards of practice for nutrition in diabetes care).

 Use G0270 for an individual patient’s reassessment and subsequent 

interventions after completion of the 3 hours of basic coverage (code 

97802) already provided in the same calendar year.

 Use G0271 for a patient’s group reassessment and subsequent

interventions following completion of the 3 hours of basic coverage 

(code 97804) already provided in the same calendar year.

 Use telehealth modifier GT for MNT via interactive audio and video 

telecommunications.

 Use telehealth modifier GQ for services via asynchronous 

telecommunications system.
Step 4: Learn More about Procedural (CPT) Codes and Diagnosis (ICD-9) Codes for Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 24

What are the IHS Patient and Family Education (PFE) Education Protocols and 

Codes?

The IHS Patient and Family Education (PFE) Protocols and Codes are another key part of the 

IHS documentation process. The codes are not required for reimbursement, but they are 

essential for documenting and tracking nutrition services provided by RDs. 

Any health care provider who provides patient education can use the PFE codes. The codes 

provide a quick method for documenting the education given during a patient visit. When 

properly documented, these education codes appear on the RPMS health summary. This 

informs health care providers if a patient has received education on specific topics as well as 

the patient’s level of understanding, readiness to learn, barriers to learning, and behavior 

changes assessed during the encounters. 

When a RD provides nutrition education, use the “MNT” code instead of the “N” code. Only 

RDs can use the “MNT” code when documenting nutrition education. All other education 

topics such as physical activity, medications, behavioral health, and follow-up should be 

documented using the general codes. 

Some codes also are used for tracking and synthesizing data for the Government Performance 

and Results Act (GPRA) indicators, Joint Commission on Accreditation of Healthcare 

Organizations (JCAHO), and Clinical Reporting System (CRS). 

For more information on the IHS PFE protocols and codes, visit the IHS Health Education 

Program website: 

http://www.ihs.gov/NonMedicalPrograms/HealthEd/index.cfm?module=initiative&option=all&

newquery=1

“Talking with Paula has kept me accountable and on track and has helped me 

realize just how serious diabetes is and how I can control diabetes with the 

information she told me.”

Ramona Sandoval, patient of dietitian Paula Maslonka, IHS Winnebago/Omaha 

Comprehensive Health Care Facility, Winnebago, NE
Step 5: Document MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 25

Step 5: Document MNT Services

“The Electronic Health Record has enabled IHS to improve patient care documentation, 

patient continuity of care, and the process for reimbursement for services provided.”

CDR Leslye Rauth, Clinical Application Coordinator, 

Office of Information Technology, IHS Headquarters 

To obtain reimbursement for MNT services, you must properly document the services that you 

provide. Medicare and other government insurance programs, private sector insurance 

companies, and health care accrediting agencies require that you submit complete and 

accurate documentation. 

What information do I need to document?

The American Dietetic Association (ADA) has developed the Nutrition Care Process and Model 

as a tool to guide RDs through the critical thinking process of providing professional services. 

The model also establishes standardized language for nutrition assessment, nutrition diagnosis, 

nutrition intervention, and nutrition monitoring and evaluation. Documentation using the 

format of the Nutrition Care Process Model has replaced the previously used Subjective, 

Objective, Assessment, and Plan (SOAP) format. Use of this new standardized language by all 

RDs and nutrition professionals will facilitate data collection and analysis for showing improved 

health outcomes. (See Appendix E for additional information about the Nutrition Care Process 

and Model.)

The CMS requires qualifying RDs and nutrition professionals to use nationally recognized 

protocols to document MNT services. The ADA has developed nationally recognized protocols, 

also known as evidence-based guidelines. The ADA’s Nutrition Practice Guidelines describe the 

information you need for documenting MNT visits (see Table 2). 

Many dietitians and nutrition professionals now are using these evidence-based guidelines for 

documenting services provided. To review the diabetes and chronic kidney disease evidencebased nutrition practice guidelines, go to the ADA Evidence Analysis Library at 

http://www.adaevidencelibrary.com/ (note: to access the library, you need to be a member 

of the ADA). 
Step 5: Document MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 26

Table 2: Overview of Information Needed to Document MNT Reimbursement

Initial MNT visit: 

60-90 minutes

Follow-up MNT visits: 

30-45 minutes

 Receipt of referral from the treating 

physician and the name of the primary 

dietitian

 Diagnosis (provided by the treating 

physician)

 Reason for the visit

 Start and stop time and date of the visit

 Step 1. Nutrition Assessment

Obtain and collect data

Analyze and interpret using evidence-based 

standards

 Step 2. Nutrition Diagnosis

 Identify and label problem.

Cluster signs, symptoms, and defining 

characteristics

 Determine cause and contributing risk 

factor

 Step 3. Nutrition Intervention

 Plan: Formulate goals and determine a 

plan of action with client

Implement: Deliver care and carry out actions

 Step 4. Nutrition Monitoring and 

Evaluation

Monitor progress

Measure outcome indicators

Evaluate outcomes

 Schedule follow-up appointment

 Include RD signature

 Start and stop time and date of the visit

 Lab data and measurements

 Progress to goals

 Adjustments to care plan

 Interventions: New and reinforcement 

MNT services, and rationale for the new 

treatment

 Barriers and solutions

 Follow-up plans

 Discharge of patient (when MNT is 

complete or patient ends services)

Include RD signature

Please refer to Appendix D for a case study that describes how to document MNT services 

during the initial and follow-up visits in the Indian health system using the ADA-recommended 

format. 
Step 5: Document MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 27

What documentation forms are used in the IHS?

Many health care providers in the IHS are now using the Electronic Health Record (EHR) for 

documenting MNT services. The figure below highlights the sites using EHR in Indian health 

facilities.

Figure 1: Indian Health Facilities Using Electronic Health Record

EHR Outpatient Sites 

as of 08/03/09

Tribal Health Ctr/Stn 91

Urban Health Ctr/Stn 3

Tribal Hospital 8

Federal Health Ctr/Stn 74

Federal Hospital 31

Some facilities may be documenting MNT services using the PCC Ambulatory Encounter 

Record for face-to-face patient encounters. Some Tribes may be using a different 

documentation form. There may be other facility-approved forms.

Regardless of which form you use, you need to ensure that the forms are complete and 

accurate so that the data entry and billing offices can submit the claim for reimbursement:

• Enter the start time and end time of the visit.

• Enter the clinic number.

• Include the treating physician referral.

• List the diagnosis(es) from the treating physician.

• Enter the MNT CPT codes. 

Enter the patient education codes (for more information on the Patient and Family Education 

codes, see the IHS Health Education Program website: 

http://www.ihs.gov/nonmedicalprograms/healthed/).

• Sign the form, as the RD or nutrition professional who provided the MNT services.

• Remember, billable time is face-to-face.
Step 5: Document MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 28

Note: The IHS recommends that you document the exact patient encounter start time and end 

time. The billing office will translate the start and end times of the visit into appropriate time

units when submitting a patient claim. (See Appendix B for a sample PCC Ambulatory 

Encounter Record.)

Other methods of documenting MNT services within the IHS include: 

• PCC+ Customizable Encounter Form—can be customized electronically by the provider or 

the clinic

• PCC Group Preventive Services Form—used to document group encounters. 

How are units of MNT Services documented?

MNT services are billed in 15-minute incremental units. Refer to the chart below to determine 

the correct number of units for the actual amount of face-to-face time with a patient. 

Table 3. CMS Guidelines for Counting Minutes for Timed Codes in 15-Minute Units

Units of Service Time with Patient

1 ≥ 8 minutes - 22 minutes

2 ≥ 23 minutes - 37 minutes

3 ≥ 38 minutes - 52 minutes

4 ≥ 53 minutes - 67 minutes

5 ≥ 68 minutes - 82 minutes

6 ≥ 83 minutes - 97 minutes

7 ≥ 98 minutes - 112 minutes

8 ≥ 113 minutes - 127 minutes

Source: Centers for Medicare & Medicaid Services (CMS). Pub 100-04 Medicare Claims 

Processing Transmittal 1019. 

What is the MNT superbill for claims processing activities? 

A superbill, also known as an encounter or charge ticket, is an efficient way to document care. 

Although a superbill is not submitted to Medicare, Medicaid, or third party health insurance, 

you can use it to identify billable MNT services for the billing office. 

A superbill is particularly beneficial if you are using the standard PCC Ambulatory Encounter 

Record or PCC+ Customized Encounter Form, rather than the Electronic Health Record, to 

document MNT services. The Electronic Health Record and PCC+ Customized Encounter Form 

incorporate the CPT and ICD-9 codes into computer-generated forms, minimizing coding errors 

for data entry and billing. The PCC Ambulatory Encounter Record, on the other hand, does not 

include codes unless someone manually adds them. 

To help remedy this problem, the superbill includes a list of ICD-9 and CPT codes and should 

include areas for entering the following information:

• MNT CPT codes 

• Clinic name and address

• RD provider information, such as name, phone and fax number, and signature

• Patient name

• Start time and end time of visit
Step 5: Document MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 29

• Referring treating physician and date and 

• Referring physician’s and RD’s NPI number will be inserted when the claim is submitted 

by the billing office.

Appendix B includes a sample IHS electronic health record (EHR) superbill and sample superbill 

with telehealth modifier. You may want to consult with your billing or data entry office 

before adopting, modifying, or creating a superbill. They may be helpful in providing 

suggestions on the format and content.
Step 6: Track MNT Services and Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 30

Step 6: Track MNT Services and Reimbursement

“Team Work is needed to increase the revenue 

generated for IHS facilities. We all must focus 

on ways to increase available health dollars to 

help expand services that may be provided at 

our facilities.”

Roslyn Bolzer, Supervisory Dietitian, IHS Rosebud 

Hospital, Rosebud, SD

(L to R): Julie Willcuts, Business Office Manager, 

Roslyn Bolzer, Tanya Pearman, Lead Billing Technician (standing), and Chrisann Long, Billing 

Technician, IHS Rosebud Hospital

Tracking MNT services and reimbursement provides a wealth of information for you and your 

MNT practice. Consider developing or adapting a tracking system that will help you record 

patient visits, the MNT services that you provide, and reimbursement for MNT services. See 

Appendix B for a sample Third Party Reimbursement Tracking Form and a sample RPMS Billing 

Report.

What are the benefits of tracking MNT services and reimbursement?

A tracking system for MNT services and reimbursement offers a number of benefits: 

It can help you avoid common mistakes that may affect claim reimbursement such as a missing 

NPI or misspelled beneficiary name. 

• It can help you avoid exceeding the number of billable hours allowed for initial and 

follow-up visits. Since Medicare allows for additional MNT services in the same calendar 

year with another physician referral that documents a change in condition, diagnosis, or 

treatment that warrants additional MNT, a tracking system can help you bill all the 

Medicare allowable hours. 

• Tracking MNT services provides information on utilization, receipt of payment for 

submitted bills, and helps with audits to ensure proper procedures for completion of 

accurate information on claim forms. This also will help improve billing office efficiency 

by ensuring that they do not submit MNT claims for services that have exceeded 

Medicare’s billable hour limits. 

• Finally, your billing office may need to submit your claim several times before your claim 

is paid. A tracking system can help you follow the resubmission process and ensure that 

your billing office is aggressive about seeking payment for your claims. 
Step 6: Track MNT Services and Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 31

What questions should my tracking system address?

Your tracking system should address the following questions to ensure that claims are 

submitted properly:

• Were the correct MNT CPT codes, time units, and indication of individual and group visits 

properly entered?

• Were the NPI for the treating physician and RD correctly entered?

• Was the diagnosis code included?

• Does the patient qualify for Medicare Part B benefit? (i.e.--was the patient enrolled in 

Medicare Part B and have the qualifying criteria for the MNT service?)

• How many hours of MNT were provided?

What should a good tracking system include?

A good tracking system should include the following information:

• Dates of service

• Patient’s initials and/or medical record number

• An indication that the treating physician referred the patient

• Type of coverage (e.g., Medicare Part B or private insurance)

• Diagnosis and ICD-9 codes

• Service provided, minutes of service, and MNT CPT code

• Dollar amount and percent of charge reimbursed

• RDs who provided MNT services to the patient

• Setting (e.g., clinic or hospital) that submitted the claim, if the location of your service 

varies

• Comment section to document additional information, such as why a claim was denied, 

why a claim was not submitted, or what action you have taken on a claim (e.g., 

resubmitting the claim with corrected or additional information).

Most IHS claims are submitted electronically. The turn-around time for accepted claims is 

minimal, usually 14 days. However, it may take more time for you to be notified if your claim 

has been denied for payment. 

If the claim is denied, the billing office is responsible for following up on each unpaid claim to 

ensure optimal reimbursement. Depending on the reason for the denied claim, the billing 

office will notify the Medicare fiscal intermediary or review the existing supporting 

documentation to resubmit the claim for payment. This step is critical and needs to be 

performed within the timely filing limits set forth by the Medicare fiscal intermediary. 

Otherwise, the Medicare fiscal intermediary will not consider the claim for payment. See the 

Top Ten Documentation Errors to Avoid on the following page.
Step 6: Track MNT Services and Reimbursement

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 32

Your business office may need to submit a claim several times before it is 

reimbursed fully. To maximize collections and minimize the number of claims 

that need to be resubmitted, try to avoid these documentation errors.

1. Diagnosis 

• ICD-9 codes missing or invalid

• Solution: Provide the ICD-9 code to the highest level of specificity (i.e., include 

all five digits)

2. Procedure code 

• CPT missing or invalid 

• Solution: Provide the correct CPT

3. Quantity billed

• Units of service out of the billable range

• Incorrect unit format

• Solution: Units of service must be equal to or greater than 1 unit of service, but 

less than 99 units of service. Units of service must follow the following format: 1 

unit = 0010 (the fourth digit is the tenths place for decimals)

4. Beneficiary name, identification number, and sex (gender)

• Name misspelled, which may result in an inability to match eligible file

• Identification number (e.g., social security number) missing, incomplete, or 

incorrect

• Gender missing or incorrect

• Solution: Provide the correct and complete name, identification number, and 

sex of the beneficiary

5. Billing provider 

• Assigned group number and NPI of billing provider missing or incorrect

• Solution: Provide the correct group and NPI number

6. Late filing

• Solution: File claim forms before the deadline. Check with your billing office 

staff to determine appropriate filing deadlines

7. Modifiers 

• Modifiers inappropriate, invalid, or missing

• Solution: Provide correct modifiers

8. Performing provider number 

• NPI missing, incorrect, or does not match group practice number.

• Solution: Provide the correct NPI of performing provider

9. Place of service 

• Place of service missing or invalid

• Solution: Provide the place of service

10.Payment Name and Address 

• Incorrect payment name and address

• Solution: Provide the correct name and address to which payment should be 

made and sent (e.g., Indian Health Service clinic name and address)

Top Ten Documentation Errors to Avoid
Step 7: Market MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 33

Step 7: Market MNT Services

“Medical Nutrition Therapy improves patient 

outcomes, quality of life, and lowers health care costs.”

CAPT Tammy Brown, Nutrition Consultant, IHS Division of 

Diabetes Treatment and Prevention, Albuquerque, NM 

(L to R): 

CAPT Tammy Brown with LCDR John E. 

Rael, Management and Program Analyst, 

IHS Office of Resource Access and 

Partnerships, Albuquerque, NM

MNT Works

• In IHS studies, patients receiving 

MNT from a RD have better diabetes and lipid control, including:

• Significantly better A1C levels (diabetes control) from RD education compared to non-RD.

• 18% reduction in cholesterol/HDL ratio

• National research on MNT has found:

• 1- to 2-unit improvement in A1C 

• LDL decrease of 12% to 16%

• Weight loss with lifestyle intervention

• Improved patient satisfaction in health programs providing MNT

MNT Saves Money

• MNT reduces physician visits and hospital admissions for diabetes and cardiovascular 

disease.

• MNT reduces drug costs for treating cholesterol and diabetes.

MNT Makes Money

• Medicare and other third party payers will reimburse for MNT.
Step 7: Market MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 34

The scientific literature provides strong and convincing evidence that people with diabetes and 

metabolic conditions benefit from MNT when delivered as part of a comprehensive plan of care 

by a multidisciplinary team. Registered dietitians know this, but do patients, clinic or hospital 

administrators, billing office staff, and physicians know this? It is important that RDs market 

and promote MNT services and: 

• Let patients, their families, and the community know that RDs are available to provide 

healthy lifestyle management education integrated into medical management, such as 

personalized meal planning and exercise counseling.

• Educate people, including health care managers, that MNT services make a difference, 

improve patient outcomes, and provide a source of revenue.

• Inform physicians, contract health services, and billing office staff of the role they play in 

ensuring that MNT services are provided to patients and are reimbursed. Ask to be on 

the agenda at upcoming medical staff meetings to discuss referral procedures and MNT 

services. Meet with providers to develop policies for treating physicians to refer patients 

for MNT. 

Share information on the MNT reimbursement process 

The handouts and guides described below provide information on the MNT Medicare benefit 

and referral process. You can share this information with health care providers and business 

managers to help them better understand the MNT reimbursement process. 

• The IHS Division of Diabetes Treatment and Prevention has developed a summary chart 

on “Indian Health Facilities Medicare Part A and B Coverage and Billing Requirements for 

MNT and DSMT” (see Appendix A). You can help physicians, other health care providers, 

and billers understand Medicare-covered services for MNT and DSMT by sharing this 

chart with them. Make copies of the chart and distribute it to these staff members.

• The ADA and the American Association of Diabetes Educators (AADE) have developed a 

referral form called, “Diabetes Services Order Form for DSMT and MNT Services.” You 

can use this form to encourage physicians and other health care providers to make 

referrals for MNT and DSMT services (remember: only physicians can make referrals for 

MNT). See Appendix B for a copy of the diabetes referral form.

• Be proactive. Get your message out in newsletters and at staff meetings. Distribute the 

Invest in Nutrition flyer in Appendix F to staff throughout your facility.
Step 7: Market MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 35

Offer an in-service training program

You can develop an in-service training program 

for your health care team on MNT services and 

Medicare reimbursement. Partner with your 

Billing Office team to deliver the presentation. 

The IHS Division of Diabetes Treatment and 

Prevention has developed ready-to-use 

PowerPoint presentations with speaker notes. 

You can use the PowerPoint presentations as 

is, or you can modify them to suit your local 

needs. Contact the IHS Division of Diabetes 

Treatment and Prevention for the current 

PowerPoint presentation.

Provide follow-up events

After sharing information and offering inservice programs, consider providing regular 

follow-up information sessions and thank you 

events. These follow-up events can help nurture your relationships with the health care team 

and help grow your nutrition practice. Referrals are a key factor to success.

L to R: Sandra Poitra, Community 

Dietitian, Betty Hunt, Billing Office 

Medical Support Assistant, Lisa Belgarde, 

Billing Office Lead Medical Support 

Assistant, and Jody Rosendahl, Supervisory 

Dietitian IHS Turtle Mountain 

 
Step 7: Market MNT Services

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 36

Steps for MNT Reimbursement
SECTION THREE

Resource Materials

Appendix A: Summary Chart on IHS Medicare Part A and B Coverage and Billing Requirements 

for MNT and DSMT 

Appendix B: Sample Forms

Appendix C: Indian Health Case Study Using Electronic Health Record (EHR) and Nutrition 

Practice Guidelines via the Nutrition Care Process 

Appendix D: Indian Health Case Study Using PCC Ambulatory Encounter Record and Nutrition 

Practice Guidelines via the Nutrition Care Process

Appendix E: Nutrition Care Process and Model

Appendix F: Additional Resources

Appendix G: Glossary

Appendix H: References
Appendix A: Summary Chart on IHS Medicare Part A and B 

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 38

Appendix A: Summary Chart on IHS Medicare Part A and B 

Coverage and Billing Requirements for MNT and DSMT

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

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.

Effective January 1, 2006, CR4204 expands to 

include Registered Dietitians and nutrition 

professionals as practitioners eligible to furnish 

and receive payment for telehealth. CMS 

expanded the list of Medicare telehealth services 

to include individual MNT as described by HCPCS 

codes G0270, 97802, 97803. 

CMS -1502-FC.

In January 2011, CMS added group MNT to 

reimbursement-eligible services.

Section 4105 of the Balanced Budget Act 

(BBA) of 1997 permits Medicare 

coverage of outpatient diabetes selfmanagement training (DSMT) services 

when these services are furnished by a 

certified provider who meets certain 

quality standards, effective July 1, 1998.

In Jan 2011, CMS added individual and 

group DSMT services as covered 

services.

Definitions (Related to 

Medicare Coverage)

MNT means nutritional diagnostic, therapeutic, 

and counseling services provided by a registered 

dietitian or nutrition professional for the purpose 

of managing diabetes or renal disease.

DSMT means providing overall guidance 

on all aspects of diabetes selfmanagement and glycemic control and is 

designed to increase the patient’s 

knowledge and skill about the disease, 

promote self-management behaviors, 

and prevent complications.

Provider Qualifications 

and Requirements

Registered dietitian (RD) or nutrition professional 

who meet the following criteria:

Minimum of BS degree in nutrition or dietetics

Completion of 900 hours of dietetics practice 

under supervision of RD or nutrition professional

Licensed or certified as an RD or nutrition 

professional by state in which services are 

performed (federal employees can be licensed or 

certified in any state)

RD 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 12/21/00

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 the Indian Health Service, 

American Association of Diabetes 

Educators, and the American Diabetes 

Association.

NOTE: A diabetes education program 

cannot seek reimbursement from 

Medicare until the program has been 

accredited.
Appendix A: Summary Chart on IHS Medicare Part A and B

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 39

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

Qualifying Diagnoses Diabetes*

 Type 1

 Type 2

Kidney:

 Non-Dialysis Kidney Disease.

 Post-Kidney Transplant within the last 6 

months.

*“Diabetes” is diabetes mellitus, a condition of 

abnormal glucose metabolism, diagnosed using 

the following criteria:

 FBS ≥ 126mg/dl on two different 

occasions.

 2-hour post glucose challenge 

≥200mg/dl on 2 different occasions.

 Or, a random glucose test over 

200mg/dl for a person with symptoms 

of uncontrolled diabetes.

Note: At the time of this printing, Medicare 

does not cover MNT for people with prediabetes.

“Diabetes” is diabetes mellitus, a 

condition of abnormal glucose 

metabolism, diagnosed using the 

following criteria:

 FBS ≥ 126mg/dl on two 

different occasions.

 2-hour post glucose challenge 

≥200mg/dl on 2 different 

occasions.

 Or, a random glucose test over 

200mg/dl for a person with 

symptoms of uncontrolled 

diabetes.

Note: At the time of this printing, 

Medicare does not cover DSMT for 

people with pre-diabetes.

Limitations of 

Coverage

 No coverage for maintenance dialysis.

 If beneficiary has diabetes and kidney 

disease, the number of hours allowed is 

for diabetes or kidney disease.

 Only face-to-face time with patient. 

 Both DSMT and MNT services cannot be 

billed even though both services were 

provided on the same date.

 For telehealth, the originating site must 

be located in either a non-MSA county 

or rural health professional shortage 

area.

 No payment will be made for 

group sessions unattended

(class attendance sheet).

 Only face-to-face time with 

patient.

 Both DSMT and MNT services 

cannot be billed even though 

both services were provided on 

the same date.
Appendix A: Summary Chart on IHS Medicare Part A and B

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 40

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

Other Conditions of 

Coverage

 The number of hours covered in a 12-

month calendar year (episode of care) 

cannot be exceeded.

 Services can be provided on an 

individual or group basis.

An exception to the maximum number of hours 

may be made if the treating physician 

determines that there is a change of diagnosis, 

medical condition, or treatment regimen related 

to diabetes or renal disease and provides a new 

referral.

The training must meet the following 

conditions:

 Following an evaluation of the 

beneficiary’s need for training, 

the treating provider must order 

DSMT.

 Included in a comprehensive 

plan of care (POC).

 It is reasonable and necessary 

for treating or monitoring the 

beneficiary’s condition (signed 

statement of need).

 When training under a POC is 

changed, the provider must 

sign it.

 In the initial DSMT benefit, 9 of 

the 10 hours must be provided 

in a group setting (2–20 

individuals) unless special 

conditions exist.

 The beneficiary can be eligible 

for 2 more hours of follow-up 

with a written order. The 2 

hours of follow-up can be group 

or one-on-one.

Practice Settings Included: Hospital outpatient department, freestanding clinics, and Home Health.

Excluded: Inpatient stay in hospital or skilled 

nursing facility.

FQHC/RHC: Covered, but included in the allinclusive encounter rate; not separately billable.

Included: Hospital outpatient department 

and free-standing clinic.

Excluded: Inpatient hospital, skilled 

nursing facility, nursing home, or 

hospice.

FQHC/RHC

Basic Coverage

: Covered, but included in the 

all-inclusive encounter rate; not 

separately billable.

Initial MNT: 3 hours per calendar year in the first 

year.

(MNT services covered by Medicare include: an 

initial nutrition and lifestyle assessment, nutrition 

counseling, diet management, follow-up sessions 

to monitor progress)

Initial DSMT: 10 hours per year in the 

first year (1 hour individual assessment 

or specialized training plus 9 hours group 

classes). Continuous 12-month period 

need not be on calendar-year basis.
Appendix A: Summary Chart on IHS Medicare Part A and B

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 41

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

Second Physician 

Referral

Follow-up MNT: 2 hours per calendar year in 

subsequent years.

Hours can be spread over any number of 

visits during the year (1 visit = minimum 

of 15 min.)

The number of hours can be increased if the 

treating physician determines there is a change 

in medical condition, diagnosis, and/or treatment 

plan and orders additional hours during that 

episode of care. If an RD determines that a 

Medicare consumer needs more time to 

understand and make behavior changes to meet 

the MNT goals, then the RD obtains a new 

referral from the treating physician for additional 

hours of MNT.

Follow-up DSMT

DSMT and MNT 

Benefits

: 2 hours per calendar 

year in subsequent years (individual or 

group training).

Hours can be spread over any 

number of visits during the year (1 

visit = minimum of 30 min.)

The CMS considers DSMT and MNT services to 

complement each other. 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.

SAME

Referring (Licensed) 

Providers

Treating physician. Physician or qualified non-physician 

practitioner: nurse practitioner, clinical 

nurse specialist, physician assistant, 

nurse midwife, clinical psychologist, and 

clinical social worker who is managing 

the beneficiary’s diabetes condition.

Provider Referral Physician written referral containing qualifying 

diagnosis and signature for each episode of care.

Provider written and signed referral for 

training containing diagnosis and a 

written comprehensive plan of care 

(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 

diabetes condition.
Appendix A: Summary Chart on IHS Medicare Part A and B

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 42

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

Protocols or 

Standards

RDs and nutrition professionals should use 

nationally recognized protocols such as the 

American Dietetic Association’s MNT EvidencedBased Guides for Practice.

Indian Health Service Integrated 

Diabetes Education Recognition 

Program (IDERP) based on IHS 

Diabetes Standards of Care and National 

Standards for Diabetes Education. Only 

program in nation that integrates 

educational, clinical, and public health 

standards.

“or”

American Diabetes Association 

Recognition Program based on the 

National Standards for Diabetes SelfManagement Education.

“or”

American Association of Diabetes 

Educators (AADE) Diabetes 

Education Accreditation Program

based on National Standards for 

Diabetes Self-Management Education.

Billable to Fiscal 

Intermediary: 

Medicare Part A

Hospital outpatient clinic department and 

grandfathered clinics MUST bill to the fiscal 

intermediary on a CMS 1450 (UB-92). Payment is 

included in the all-inclusive rate; not separately 

billable.

Telehealth: the originating site bills the allinclusive rate 

FQHC – Yes, but costs are bundled into the allinclusive encounter rate.

Hospital outpatient clinic department and 

grandfathered clinics MUST bill to the 

fiscal intermediary on CMS 1450 (UB92). Payment is included in the allinclusive rate; not separately billable.

FQHC – Yes, but costs are bundled into 

the all-inclusive encounter rate. 

Billable to Medicare 

Carrier: Medicare 

Part B

Freestanding clinics bill the carrier on CMS 1500.

Telehealth: the distant site bills for the 

professional services using the appropriate CPT 

code along with the appropriate telehealth 

modifier.

Freestanding clinics bill the carrier on 

CMS 1500.

National Provider 

Identifier (NPI)

RD or nutrition professional must enroll in the 

Medicare program and obtain a National Provider 

Identifier (NPI), to become a recognized 

Medicare provider. Apply online from the 

National and Provider Enumeration System 

contractor at: 

https://nppes.cms.hhs.gov/NPPES/Welcome.do

N/A

Enrolling as Medicare 

Provider

In addition to applying for a NPI, complete CMS 

Form 855I, “Medicare Enrollment Application—

Physician and Non-physician Practitioners. You 

can access the form online at:

http://www.cms.hhs.gov/cmsforms/downloads/c

ms855i.pdf

Referring provider must be enrolled as a 

Medicare Part B Provider. Once diabetes 

education program recognition is 

received, a copy of the IHS, ADA or 

AADE certificate must be submitted to 

Medicare.

CMS Form 855 for 

Reassignment of 

Benefits

Complete CMS Form 855R, “Medicare Federal 

Care Reassignment of Benefits Application,” to 

reassign benefits back to employer.

N/A
Appendix A: Summary Chart on IHS Medicare Part A and B

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 43

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

CPT or HCPCS Codes 97802: Initial, individual MNT visit; initial 

assessment and intervention, face-to-face with 

the patient, each 15 minutes 

97803: Follow-up, individual MNT visit; reassessment and intervention, face-to-face with 

the patient, each 15 minutes 

97804: Group MNT (2 or more individuals), 

each 30 minutes

G0108 Outpatient DSMT services, 

individual, each 30 minutes.

G0109 Outpatient DSMT services, group 

session, (two or more), each 30 minutes.

Telehealth Modifiers “GT” (via interactive audio and video 

telecommunications system—“real-time” through 

the use of video conferencing equipment)

“GQ” (via asynchronous telecommunications 

system—“store and forward technology)

“GT” (via interactive audio and video

telecommunications system—“real-time” 

through the use of video conferencing 

equipment)

“GQ” (via asynchronous

telecommunications system—“store and 

forward” technology)

Second Physician 

Referral (G Codes)

G0270: Medical Nutrition Therapy; 

reassessment and subsequent intervention(s) 

following second referral in same year for 

change in diagnosis, medical condition, or 

treatment regimen (including additional hours 

needed for renal disease), individual, face-toface with the patient, each 15 minutes. 

G0271: Medical Nutrition Therapy 

reassessment and subsequent interventions(s) 

following second referral in same year for 

change in diagnosis, medical condition, or 

treatment regimen (including additional hours 

needed for renal disease) group visit (2 or more 

individuals), each 30 minutes.

Free-Standing Clinics: Multiple units of the codes 

can be used based on medical necessity and the 

complexity of the MNT decision-making.

Outpatient Hospital Programs

Not Applicable

: Report one (1) in 

the units field regardless of the time spent in the 

session. Use revenue code 510.

Free-Standing Clinics: Multiple units of 

the codes can be used based on 

class/session design.

Outpatient Hospital Programs: Report 

one (1) in the units field regardless of 

the time spent in the session. Use 

revenue code 510.
Appendix A: Summary Chart on IHS Medicare Part A and B

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 44

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

Payment Free-Standing Clinics

 RDs should establish a fee schedule 

(based on usual and customary MNT 

fees) for their MNT services.

:

 Allowed payment rates have been 

established under the physician fee 

schedule.

 Payment will be 80% (because a 20% 

co-pay applies) of the lesser of either 

the actual charge or 80% of the 

physician fee schedule amount.

 The CMS applies a geographical 

adjustment factor (GAF) to the MNT 

rates in regions of the country.

 Deductible and coinsurance apply.

Hospital outpatient facilities: Included in AllInclusive rate payment. Deductible and 

coinsurance apply.

Free Standing Clinics: Medicare Part B 

fee schedule based on geographic state. 

Deductible and coinsurance apply.

NOTE: 

1. Non-physician practitioners (e.g., RDs 

or nutrition professionals who are 

Medicare providers, are eligible to bill 

Medicare Part B on behalf of the DSMT 

program. 

2. Payment to non-physician 

practitioners billing on behalf of the 

DSMT program should be made at the 

full physician fee schedule. This is 

because the payment is for the DSMT 

program and is not being billed for the 

services of a single practitioner. 

Hospital outpatient facilities

Billing for Services 

Not Covered

: Included in 

All-Inclusive rate payment. Deductible 

and coinsurance apply.

Medicare Part B cannot be billed for non-covered 

MNT or for non-covered MNT services as 

“incident to physician’s services.”

Medicare Part B cannot be billed for noncovered DSMT.

Medicare Part B 

Documentation 

Requirements

 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*

(*Recommended to facilitate timely and accurate 

billing)

 Patient name/medical record 

number

 Qualifying medical diagnosis 

indicating condition requiring 

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*

(*Recommended to facilitate timely and 

accurate billing)

Resources: Medicare 

Part A

 IHS Handbook

 www.trailblazerhealth.com/parta/ihs

 IHS Handbook

 www.trailblazerhealth.com/parta/i

hs
Appendix A: Summary Chart on IHS Medicare Part A and B

Coverage and Billing Requirements for MNT and DSMT

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 45

Medicare Benefits & 

CMS Coverage 

Guidelines

MNT

Medical Nutrition Therapy

DSMT

Diabetes Self-Management Training

Resources: Medicare 

Part B

 Medicare Part B Newsletter 9/1/2001. 

No 01-020. Pages 27–28.

 www.trailblazerhealth.com/partb/ihs

 ADA Web site: www.eatright.org

 Electronic Code of Federal Regulations 

Title 42: Public Health, Chapter IV 

(MNT) 

 Medicare Part B Newsletter 

9/1/2001. No 01-020. Pages 

31–32.

 www.trailblazerhealth.com/partb/i

hs

 AADE Web site: 

http://www.diabeteseducator.or

g

 Electronic Code of Federal 

Regulations Title: 42: Public 

Health, Chapter IV (DSMT)

Claim Follow-up Medicare B IHS hotline: 1-866-448-5894.

Ask for claim check status. Have available 

patient Medicare number and date of service.

Trailblazer DDE online system: Each facility 

business office should have access to this 

electronic system.

Medicare IHS hotline: 1-866-448-5894. 

TrailBlazer’s DDE Online System. Each 

facility’s business office may have access 

to this electronic system.
Appendix B: Sample Forms 

IHS MNT Referral Form (Electronic Version)

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 46

Appendix B: Sample Forms

1. IHS MNT Referral Form (Electronic Version)
Appendix B: Sample Forms 

IHS MNT Referral Form (Electronic Version)

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 47

IHS MNT Referral Form (Electronic Version) –Continued 
Appendix B: Sample Forms 

IHS MNT Referral Form (Electronic Version)

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 48

IHS MNT Referral Form (Electronic Version) –Continued
Appendix B: Sample Forms 

IHS MNT Patient Referral Notice IHS Form 199-1

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 49

2. IHS MNT Patient Referral IHS Form 199-1
Appendix B: Sample Forms

MNT Superbill – Electronic Health Record Version

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 50

3. MNT Superbill – Electronic Health Record Version
Appendix B: Sample Forms 

MNT Superbill with Telehealth Modifier

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 51

4. MNT Superbill with Telehealth Modifier
Appendix B: Sample Forms 

Third Party Reimbursement Tracking Form and Instructions

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 52

5. Third Party Reimbursement Tracking Form and Instructions
Appendix B: Sample Forms 

Third Party Reimbursement Tracking Form and Instructions

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 53

Third Party Reimbursement Tracking Form and Instructions –Continued
Appendix B: Sample Forms

CMS Form 1500 (Health Insurance Claim Form)

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 54

6. CMS Form 1500 (Health Insurance Claim Form)
Appendix B: Sample Forms

Diabetes Service Order Form (DSMT and MNT Services)

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 55

7. Diabetes Services Order Form (DSMT and MNT 

Services)
Appendix B: Sample Forms

PCC Ambulatory Encounter Record

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 56

8. PCC Ambulatory Encounter Record
Appendix B: Sample Forms

RPMS Billing Report

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 57

9. RPMS Billing Report

RPMS Billing Report Sample

=====================================================================

LISTING of ALL BILLS for ALL BILLING SOURCES SEP 24, 2009 Page 1

with APPROVAL DATES from 01/01/2009 to 09/24/2009 provided by DEBBIE DIETITIAN

with PROCEDURE RANGE from 97802 to 97804

Billing Location: SUNSHINE HOSPITAL

=====================================================================

 Claim Export Billed Date Paid

 Insurer Number HRN Date Amount Paid Amount

-------------------------------------------------------------------------------

=====================================================================

STATISTICAL REPORT for ALL BILLING SOURCES SEP 24, 2009 Page 1

with APPROVAL DATES from 01/01/2009 to 09/24/2009 provided by DEBBIE DIETITIAN

with PROCEDURE RANGE from 97802 to 97804

Billing Location: SUNSHINE HOSPITAL

=====================================================================

 NUMBER UNDUP BILLED PAID UNPAID

 CLINIC VISITS PATIENTS AMOUNT AMOUNT AMOUNT

-------------------------------------------------------------------------------

(REPORT COMPLETE):

=====================================================================

STATISTICAL REPORT for ALL BILLING SOURCES SEP 23,2009 Page 1

with PAYMENT DATES from 01/01/2009 to 09/23/2009 provided by DEBBIE DIETITIAN

Billing Location: SUNSHINE HOSPITAL

=====================================================================

 NUMBER UNDUP BILLED PAID UNPAID

 CLINIC VISITS PATIENTS AMOUNT AMOUNT AMOUNT

-------------------------------------------------------------------------------

SUNSHINE HOSPITAL HO

 DIETARY 1 1 253.00 0.00 253.00

 ------ ------ ---------- ---------- ----------

 1 1 253.00 0.00 253.00

TOTAL COVERED INPATIENT DAYS 0

(REPORT COMPLETE):
Appendix C: Indian Health Case Study Using Electronic Health Record 

(EHR) and Nutrition Practice Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 58

Appendix C: Indian Health Case Study Using Electronic 

Health Record (EHR) and Nutrition Practice Guidelines 

via the Nutrition Care Process

Case Presentation

Mrs. Dancing Eagle was referred by Dr. Browning on November 1st for MNT for uncontrolled

Type 2 diabetes and weight loss.

Mrs. Dancing Eagle is a 66 year old female with Type 2 Diabetes. She was diagnosed with Type 

2 diabetes about 10 years ago, but Mrs. Dancing Eagle states that she was unaware she had 

diabetes. 

She remembers being told her sugar was high a few times over the years. She stated she is 

usually really thirsty and often gets up numerous times during the night to use the bathroom.

Mrs. Dancing Eagle was brought into the clinic after slipping and falling on the ice injuring her 

knee. At this time she was told she had diabetes.

Lab Reports from 10-18-09 Height: 62”

A1c: 11.3 Weight: 235 #

Direct Measure LDL: 130 BP: 160/95

HDL: 25 Medications: none

Triglycerides: 620

Mrs. Dancing Eagle takes care of her four grandchildren, ages 3, 5, 7, and 10.Her daughter and 

her four grandchildren live with her. She states she has no alone time, always taking care of 

everyone else. She has been having financial problems ever since her son was put in jail. She 

enjoys sewing but her arthritis in her wrist is so painful that she can no longer sew.

Usual Diet History:

Breakfast: Busy with the kids, usually 2 cups of coffee with sugar and cream, large glass of 

Sunny D, sometimes leftover supper

Lunch: Mac-n-cheese, or hot dogs, or ramen noodles, coke

Supper: pork chops, fried potatoes (fried in lard), 2 sl. white bread, sweet tea

Snacks: can’t skip dessert every night before bed, usually fruit cocktail. Fruit, candy bars, 

pastries, sweet tea. 

SMBG: none, doesn’t have meter

Exercise: housework and running after the kids

Etoh/Tobacco: neither
Appendix C: Indian Health Case Study Using Electronic Health Record 

(EHR) and Nutrition Practice Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 59

1. Initial Visit

TITLE: DIETARY NOTE 

DATE OF NOTE: NOV 10, 2009@10:00 ENTRY DATE: NOV 10, 2009@14:08:57 

AUTHOR: PHILLIPS,DIANE L EXP COSIGNER: 

URGENCY: STATUS: COMPLETED 

________________________________________________________________

 ***MEDICAL NUTRITION THERAPY ASSESSMENT***

________________________________________________________________

Dancing Eagle, Juanita, 66 year old FEMALE. Referred on 01-Nov-2009 by Dr. 

Browning.

Purpose of today's visit:

Diabetes Mellitus, Type 2, Uncontrolled [P] 

Was seen in the ER on Sunday (11-01-09), slipped feel in ice and injured her left 

knee. Was told her had diabetes during this visit. Was not aware that she had 

diabetes. Had been told a few times over the years that her sugar was high. Gets up 

frequently during the night to use the bathroom.

Social History:

---------------

Her daughter and her four children live with her. She babysits the grandkids while 

the daughter works. Grandchildren ages, 3, 5, 8, 10. Son is in jail, has been 

having a hard time financially since he has been gone. Very worried about him, as 

well. Husband died 10 years ago from cirrhosis.

Occupation: used to sew, but can no longer sew due to her wrist arthritis

Family History:

--------------

Mother had diabetes and her Dad died of a heart attack.

Mother was GDM at pt birth [.9999] - SEP 29, 2009

Nutrition & Lifestyle History:

------------------------

Usual Meals:

 Breakfast: Busy with the kids, usually 2 cups of coffee with sugar 

 and cream, large glass of orange drink, sometimes 

 leftover supper

 Lunch: Mac-n-cheese, or hot dogs, or ramen noodles, coke 

 Dinner: pork chops, fried potatoes (fried in lard), 2 sl. white 

 bread, sweet tea

 Snacks: can’t skip dessert every night before bed, usually fruit 

 cocktail. Fruit, candy bars, pastries, sweet tea. 

 Beverages: Coke, coffee, sweet tea

Food Intolerance: lactose intolerant

Self Monitoring Blood Glucose: does not have a meter

Physical Activity: Sedentary, no regular exercise, just watching 

 grandkids
Appendix C: Indian Health Case Study Using Electronic Health Record 

(EHR) and Nutrition Practice Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 60

Today's Vitals:

------------------

Weight: 235.00 lb 

Height: 62.00 in 

BMI: 43, extreme obesity

Last Blood pressures: 160/95 Nov 01, 2009 

Laboratory History:

--------------------

A1C: 11.3 Nov 01, 2009

LDL (direct measure): 130 Nov 01, 2009

HDL: 25 Nov 01, 2009

Triglycerides: 620 Nov 01, 2009

Medications:

------------

Metformin 500mg BID, simvastatin 20 mg, lisinoprol 20 mg, started on Sunday

________________________________________________________________

 ASSESSMENT 

________________________________________________________________

Total energy intake: approximately 2500 kcal/day 

Type of foods/meals: irregular meals and snacks

Total carbohydrate: processed, sugar sweetened beverages and sweets

Area(s) and level of knowledge: no diabetes knowledge

Physical activity: no regular activity. TV/screen time: 2 -3 hours per day.

Total calories, estimate needs: For weight maintenance: ~2000 kcal per day, for 

weight loss: 1500 kcal/day.

Method for estimating needs: Mifflin St. Jeor with actual weight.

________________________________________________________________

 NUTRITION DIAGNOSIS 

________________________________________________________________

Excessive carbohydrate intake related to regular intake of sugar sweetened beverages 

as evidence by diet recall and A1c level.

Food & nutrition related knowledge deficit related to a balanced diabetic diet as 

evidence by self reported knowledge.

________________________________________________________________

 NUTRITION INTERVENTION

________________________________________________________________

Nutrition Prescription: High fiber, low fat, carbohydrate controlled diet. 

Carbohydrate budget: breakfast: 30-45 grams, lunch: 30-45 grams, dinner: 30- 45 

grams, snacks: 15-30 grams. Short term goal to decrease intake by 500 kcal/day and 

increase activity and reduce carbohydrate intake. Longer term goal: decrease daily 

intake to 1500 kcal/day to decrease body weight 5-10% in 6 months. 

Modify distribution, and type, of carbohydrate for a more balanced intake. 

Purpose of the Nutrition Education, to educate patient on the importance of a 

balanced carbohydrate controlled diet. How to use blood glucose monitor and when to 

check blood sugar levels at home.

Recommended Modifications: evenly distribute carbohydrates throughout the day. 

Intervention strategy: Motivational Interviewing and Goal Setting
Appendix C: Indian Health Case Study Using Electronic Health Record 

(EHR) and Nutrition Practice Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 61

Referral to community diabetes program for educational classes, support group and 

involvement in fitness activities.

________________________________________________________________

 MONITORING EVALUATION TERMINOLOGY 

________________________________________________________________

Continue regular follow up visits to monitor carbohydrate intake and A1c levels, and 

home blood glucose levels.

Behavioral Goals:

---------------

 - Self blood glucose monitoring 2-3 times/day (am fasting and after 

 largest meal)

Timing and consistency of meals, consume regular meals and evenly distribute 

carbohydrates throughout the day

 - Switch to sugar-free beverages

Patient Goals: (patient stated goals)

---------------

Switch to diet pop

Eat regular meals, not skip meals

Watch my carbohydrate intake, limit to 2-3 servings per meal

Begin checking my blood sugar 2 – 3 times per day 

Patient Education:

------------------

1 DM-HM: 15 min.; INDIVIDUAL; Understanding-GOOD

 Comment: 

2 DM-MNT: 30 min.; INDIVIDUAL; Understanding-GOOD

 Comment: 

Scheduled Appointments:

-----------------------

Patient is scheduled to return to clinic: December 1, 2009 @ 2:00 pm

MNT TRACKING

------------

Activity Time: 

Time in: 10-Nov-2009 10:00 Time Out: 10-Nov-2009 11:10

CPT codes: MEDICAL NUTRITION, INDIV, IN Qty=4 (97802)

/es/ DIANE L. PHILLIPS, RD 

 

Signed: 11/09/2009 14:32
Indian Health Case Study Using Electronic Health Record (EHR) 

and Nutrition Practice Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 62

2. Follow-up Visit

TITLE: DIETARY NOTE 

DATE OF NOTE: DEC 01, 2009@02:00 ENTRY DATE: DEC 01, 2009@03:30 

AUTHOR: PHILLIPS,DIANE L EXP COSIGNER: 

URGENCY: STATUS: COMPLETED 

________________________________________________________________

 ***MEDICAL NUTRITION THERAPY FOLLOW UP VISIT***

________________________________________________________________

Dancing Eagle, Juanita, 66 year old FEMALE. Referred on 01-Nov-2009 by Dr. 

Browning. Initial visit, November 10, 2009.

Purpose of today's visit:

1) Diabetes Mellitus, Type 2, Uncontrolled [P] 

2) OBESITY

Patient states she is feeling much better. She has begun attending the Tribal 

Diabetes Program classes and started going to the wellness center during diabetes 

hour. She is no longer drinking regular pop and sweet tea. Using Splenda® in her 

tea and coffee.

Social History:

---------------

Daughter and her four grandchildren are stilling living with her. She was able to 

visit her son in jail and he is doing well.

Nutrition & Lifestyle History:

------------------------

Usual Meals:

 Breakfast: oatmeal, hard boiled egg, coffee with creamer and 

 Splenda®

 Lunch: soup, crackers or sandwich (ham or roast beef w/lettuce, 

 tomatoes and onion), diet coke

 Dinner: green chile stew, whole wheat tortilla (1/2) or 

 pork chops, broccoli, baked potato, water

 Snacks: fruit, raw vegetables, nuts

 Beverages: water, diet coke, coffee and tea sweetened with 

 Splenda®

Food Intolerance: lactose

________________________________________________________________

 MONITORING EVALUATION TERMINOLOGY 

________________________________________________________________

Mrs. Dancing Eagle has begun regularly monitoring her blood sugar. She is checking 

AM fasting and after lunch or supper. She is no longer using regular sugar or 

regular pop. She has begun using diet pop and Splenda®. She is trying to limit 

carbohydrates but is having a hard time understanding how to count the 

carbohydrates. She has been attending the diabetes classes at the tribal diabetes 

center and she is also attending the diabetes hour at the wellness center 3 to 5 

times per week. She is able to recall nutrition goals and is very motivated to make 

lifestyle changes. 

Self Monitoring Blood Glucose at agreed upon rate: 2-3 times per day

AM fasting: 280, 200, 178, 212, 185

Postprandial: 200, 225, 250, 195, 170
Indian Health Case Study Using Electronic Health Record (EHR) 

and Nutrition Practice Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 63

Physical Activity: Routine Exercise going to the wellness center 3 -5 times a week, 

working w/ DM Program to increase intensity and duration of cardio and weight 

workout

Today's Vitals:

------------------

Weight: 227 lbs Dec 01, 2009

Last weight: 235 lb Nov 10, 2009 

Last Height: 62in Nov 10, 2009

Last blood pressures: 149/ 80 Dec 01, 2009 

Laboratory History:

--------------------

A1C: 8.5 Nov 30, 2009

Type of foods/meals, Meal/snack pattern: 3 meals a day, and afternoon and evening 

snack. 

Total carbohydrate, Source of carbohydrate: Working on limiting intake to 2-3 

serving of carbohydrate per meal and 1 to 2 servings per snack. Including whole 

grains.

Plan: Continue to work on nutrition prescription: High fiber, low fat, carbohydrate 

controlled diet. Carbohydrate budget: breakfast: 30-45 grams, lunch: 30-45 grams, 

dinner: 30- 45 grams, snacks: 15-30 grams. Today we focused on more in depth skills 

and knowledge on carbohydrate counting in order to meet carbohydrate budget/plan. 

Reduction in A1c, weight, and BP. Patient states better understanding and is able 

to return demonstrate carbohydrate counting principles and how to read the food 

label to interrupt carbohydrate content and serving. Continue to work on reduction 

of carbohydrate intake and increase diabetes self care skills and knowledge.

Patient Goals:

---------------

Continue monitoring blood sugar 2 to 3 times per day

Continue going to wellness center, increase to 5 time per week

Begin counting carbohydrates and recording intake in log book

Patient Education:

------------------

1 DMCN-FL: 15 min.; INDIVIDUAL; Understanding-GOOD

 Comment: 

2 DMCN-CC: 30 min.; INDIVIDUAL; Understanding-GOOD

 Comment: 

Scheduled Appointments:

-----------------------

Patient is scheduled to return to clinic: January 14, 2010 @ 10:00 am

MNT TRACKING

------------

Activity Time: 

Time in: 01-Dec-2009 14:10 Time Out: 01-Dec-2009 15:20

CPT codes: MED NUTRITION, INDIV, SUBSEQ Qty=4 (97803)

/es/ DIANE L. PHILLIPS, RD 

Signed: 12/01/2009 16:33 
Appendix D: Indian Health Case Study Using PCC Ambulatory Encounter 

Record and Nutrition Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 64

Appendix D: Indian Health Case Study Using PCC Ambulatory 

Encounter Record and Nutrition Practice Guidelines via the 

Nutrition Care Process

1. Initial Visit
Appendix D: Indian Health Case Study Using PCC Ambulatory Encounter 

Record and Nutrition Guidelines via the Nutrition Care Process

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 65

2. Follow-up Visit
Appendix E: Nutrition Care Process and Model

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 66

Appendix E: Nutrition Care Process and Model

The American Dietetic Association has conceptualized quality Nutrition Care in terms of a 

series of steps as illustrated in the figure below:

• Nutrition Assessment & Re-assessment

• Nutrition Diagnosis

• Nutrition Intervention

• Nutrition Monitoring & Evaluation 

 Nutrition Care Process and Model

Source: American Dietetic Association Evidence Library. http://adaeal.com/ncp/ Accessed 

February 2010. Copyright 2010 American Dietetic Association. All rights reserved. Reprinted 

with permission.

An example of applying the Nutrition Care Process in diabetes MNT provided by a RD is shown 

in table on the following pages.
Appendix E: Nutrition Care Process and Model

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 67

Application of Nutrition Care Process in MNT for Diabetes

Application of Nutrition

Care Process (NCP)

MNT Provided by RD for Diabetes

(for individual)

Nutrition Screen/Referral The physician provider sends the RD a written referral for MNT for 

diabetes. The referral includes information regarding current labs, 

medications, and other medical diagnoses.

Nutrition Assessment The RD performs a comprehensive nutrition assessment utilizing the 

Diabetes Type 1 and 2 Evidence-Based Nutrition Practice Guideline 

for Adults and Toolkit, as well as the best available current 

knowledge and evidence, client data, medical record data, and other 

resources.

Nutrition Diagnosis After analyzing assessment data, the RD makes initial nutrition 

diagnosis(es)—i.e., inconsistent carbohydrate intake (NI-5.8.4), 

inconsistent timing of carbohydrate intake throughout the day, dayto-day, or a pattern of carbohydrate intake that is not consistent 

with recommended pattern based on physiological or medication 

needs.

Nutrition Intervention The RD provides counseling and, with the client, determines 

interventions using the cognitive-behavioral model, including 

problem solving, motivational interviewing, goal setting, and selfmonitoring. 

The RD plans follow-up over multiple visits to assist with 

behavior/lifestyle changes relative to the nutrition diagnoses and 

medical condition/disease(s).

Nutrition Monitoring and Evaluation The RD monitors hemoglobin A1c (A1C), microalbuminuria, body 

mass index, serum lipids, goals for food plan/intake, activity, and 

other behavior changes. The RD implements changes to MNT 

(patient nutrition goals, nutrition intervention, and counseling) in 

future visits based on outcomes and assessments at each visit.

Nutrition Documentation

(supports all steps of the NCP)

The RD documents MNT initial assessment, nutrition diagnosis(es), 

and intervention(s); shares documentation with referring physician 

and keeps copy on file.

Outcomes Management Systems Based on RD analysis, critical thinking, and review of data from the

patient’s medical history and other healthcare professionals, the RD 

aggregates individual and population outcomes data, analyzes and 

shares with quality improvement department/group, as indicated. 

The RD and the rest of the team implement improvements to MNT 

services based on results.

Source: American Dietetic Association Diabetes White Paper, October 2008.
Appendix F: Additional Resources

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 68

Appendix F: Additional Resources

1. IHS Medical Nutrition Therapy Action Team

First and foremost, if you have questions about Medicare reimbursement for MNT services and 

need help, please contact a member of the IHS Medical Nutrition Therapy Action Team (MAT 

Team) in your Area. These RDs are willing to help you to maximize Medicare MNT 

reimbursement for your facility. You can reach the MAT Action Team by email: 

IHSMNTActionTeam@ihs.gov

Dolores G. Addison, RD

LT, US Public Health Service

Area Diabetes Consultant

Tucson Area IHS

7900 S. J Stock Road

Tucson, AZ 85746

Dolores.Addison@ihs.gov

Karen Bachman-Carter, MPH, RD

CAPT, US Public Health Service

Nutrition Consultant

IHS Navajo Area Diabetes Program

Northern Navajo Medical Center

P.O. Box 160 (Hwy 491 North)

Shiprock, NM 87420 

Phone: 505-368-7430

Fax: 505-368-7426

Karen.Bachman-Carter@ihs.gov

Roslyn (Roz) Bolzer, RD, LN

Diabetes Coordinator/Community Nutrition

IHS Kyle Health Clinic

1000 Health Center Road - Box 540

Kyle, SD 57752

Phone: 605-455-3289

Roslyn.Bolzer@ihs.gov

Brenda Broussard, MPH, MBA, RD, BCADM, CDE

Nutrition and Diabetes Consultant

Broussard Consulting

18 Berm Street NW

Albuquerque, NM 87120

Phone: 505-792-0065

Brenda@BroussardConsulting.com

Tammy L. Brown, MPH, RD, BC-ADM, CDE

CAPT, US Public Health Service

Nutrition Consultant 

IHS Division of Diabetes Treatment and 

Prevention

5300 Homestead Rd NE

Albuquerque, NM 87110

Phone: 505-248-4182

Fax: 505-248-4188

Tammy.Brown@ihs.gov

Susan Jones, MS, RD, LD, CNSD

LCDR, US Public Health Service

Senior Clinical Dietitian

IHS Northern Navajo Medical Center

P.O. Box 160 (Hwy 491 North)

Shiprock, NM 87420 

Phone: 505-368-6209

Susan.Jones@ihs.gov

Stefanie McLain, MS, RD, LD

Community Health Department Dietitian

IHS Wewoka Service Unit

P.O. Box 1475

Wewoka, OK 74884

SH 56 & 270 Junction

Phone: 405-257-7501

Fax: 405-257-7529

Stefanie.McLain@ihs.gov
Appendix F: Additional Resources

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 69

Shanna Moeder, RD

LT, US Public Health Service

3449 Rezanof Dr.

Kodiak, AK 99615

Phone: 907-486-1362

Fax: 907-486-9897

Shanna.Moeder@kanaweb.org

Diane Phillips, RD, LD, CDE

Co-Chair, MAT Team

LCDR, US Public Health Service

Program Director

IHS Telenutrition Program

1215 N. Beaver St., Suite 201

Flagstaff, AZ 86001

Phone: 928-214-3947

Fax: 928-214-3933

Diane.Phillips@ihs.gov

Leslye Rauth, MPH, RD, CDE

Co-Chair, MAT Team

CDR, US Public Health Service

Clinical Application Coordinator

IHS Office of Information Technology 

IHS Headquarters

Leslye.Rauth@ihs.gov

LCDR Revondolyn (Faye) Scott, RD 

LT, US Public Health Service

Public Health Nutritionist

IHS Chinle Service Unit 

Piñon Health Center

P.O. Box 10

Piñon, AZ 86510

Phone: 928-725-9736 

Fax: 928-725-9544

Revondolyn.Scott@ihs.gov

Kelli Wilson, MS, RD, LD

LT, US Public Health Service

Public Health Nutritionist/Director

Community Health and Diabetes Programs

IHS Wewoka Indian Health Center

P.O. Box 1475

Wewoka, OK 74884

SH 56 & 270 Junction 

Phone: 405-257-7316

Fax: 405-257-7529

Kelli.Wilson@ihs.gov
Appendix F: Additional Resources

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 70

2. Invest in Nutrition Flyer
Appendix F: Additional Resources

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 71

3. American Dietetic Association (ADA) Evidence-Based Guidelines

Use the ADA evidence-based guidelines to apply cutting-edge, synthesized research to your 

practice! The Guidelines are FREE to ADA members. 

ADA Chronic Kidney Disease and Nutrition Evidence Analysis Project, 2008.

http://www.adaevidencelibrary.com/topic.cfm?cat=1400. 

Accessed February 2010.

ADA Diabetes Type 1 and 2 Evidence-based Nutrition Practice Guideline for Adults: 

Executive Summary of Recommendations, March 2008.

http://www.adaevidencelibrary.com/topic.cfm?cat=3252. 

Accessed February 2010.

ADA Diabetes Evidence-based Nutrition Practice Guidelines for Gestational Diabetes, 

December 2008.

http://www.adaevidencelibrary.com/topic.cfm?cat=3731. 

Accessed February 2010.

4. ADA Website MNT Reimbursement Page

American Dietetic Association web page dedicated to MNT Reimbursement.

http://www.eatright.org/HealthProfessionals/content.aspx?id=8175

http://www.eatright.org/HealthProfessionals/content.aspx?id=6863

Accessed February 2010.

5. ADA Nutrition Care Process and Terminology

International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized 

Language for the Nutrition Care Process, Second Edition, 2009, American Dietetic 

Association, Chicago, IL. 

This reference book is a comprehensive guide for implementing the Nutrition Care Process 

using standardized language for Nutrition Assessment (labels for specific data used in nutrition 

assessment and reassessment), Nutrition Diagnosis (labels for specific nutrition problem), 

Nutrition Intervention (labels for types of nutrition interventions implemented) and Nutrition 

Monitoring and Evaluating (labels for types of data used to judge effectiveness of nutrition 

care). New to this edition are the sections on Nutrition Assessment along with revisions to the 

Nutrition Diagnosis, Nutrition Intervention, and Nutrition Monitoring and Evaluation sections. 

http://www.eatright.org/Shop/Product.aspx?id=4996. Accessed February 2010.

Pocket Guide for International Dietetics & Nutrition Terminology (IDNT) Reference Manual: 

Standardized Language for the Nutrition Care Process, Second Edition, 2009, American 

Dietetic Association, Chicago, IL. 

http://www.eatright.org/Shop/Product.aspx?id=4995. Accessed February 2010.

Nutrition care process and model part I: the 2008 update. 

Writing Group of the Nutrition Care Process/Standardized Language Committee. Journal of 

the American Dietetic Association. 2008 Jul;108(7):1113-7.
Appendix F: Additional Resources

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 72

Nutrition care process part II: using the International Dietetics and Nutrition Terminology 

to document the nutrition care process.

Writing Group of the Nutrition Care Process/Standardized Language Committee. 

Journal of the American Dietetic Association. 2008 Aug;108(8):1287-93. 

6. CMS Website Medicare Learning Network 

The Medicare Learning Network website has quick reference guides, Web-based training 

modules, publications and pamphlets, videos and CD-ROMS at: 

http://www.cms.hhs.gov/mlngeninfo/ Accessed February 2010.

• The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, 

and Other Health Care Professionals.

The guide includes information on Medicare coverage of MNT. You can access this 

information on the Medicare Learning Network’s Preventive Services page: 

www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp

(Click on “Educational Products” in the “Downloads” section and select the link to the 

publication under “Guides.”). Accessed February 2010.

• CMS offers a brochure on Medicare-covered diabetes services that includes 

information on Medicare coverage of MNT. You can access this information on the 

Medicare Learning Network’s Preventive Services page: 

www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp

(Click on “Educational Products” in the “Downloads” section and “Diabetes-Related 

Services” under “Guides.”) Accessed February 2010.

7. IHS Division of Diabetes Treatment and Prevention Diabetes Best Practices 

The Indian Health Diabetes Best Practices documents (updated in 2009) cover 19 topics in 

diabetes treatment and prevention, including adult weight management, breastfeeding, 

cardiovascular disease, chronic kidney disease, nutrition and physical activity, diabetes in 

youth, and many more. Each Indian Health Diabetes Best Practice provides:

• Guidelines for the best practice 

• Key recommendations

• How to monitor progress and outcomes, including key measures 

• Specific clinical, community, and organization recommendations 

• How to evaluate and sustain your program 

• Tools and resources, including examples of current best practice programs and additional 

contacts and references 

• Specific suggestions on improving the best practice program in the Indian Health System.

• http://www.diabetes.ihs.gov/index.cfm?module=toolsBestPractices. Accessed February 

2010.
Appendix F: Additional Resources

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 73

8. IHS Division of Diabetes Treatment and Prevention Clinical Guidelines 

Resources 

The resources listed below can be found on the IHS/DDTP website at:

http://www.ihs.gov/MedicalPrograms/diabetes/index.cfm?module=toolsClinicalGuidelines. 

Accessed February 2010.

IHS Standards of Care for Patients with Type 2 Diabetes (PDF – 234 KB). Updated clinical 

guidelines for providers. Revised March 2009.

IHS Guidelines for the Care of Adults with Prediabetes and/or the Metabolic Syndrome in 

Clinical Settings (PDF – 513 KB). Updated clinical guidelines for providers. Revised September 

2008. 

Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis 

on American Indian and Alaska Native Children. Clinical report from Pediatrics (October 

2003)

Promoting a Healthy Weight in Children and Youth (PDF – 529 KB). This IHS report outlines 

clinical strategies on five childhood obesity prevention and treatment recommendations for 

health care professionals in Indian Health Service, Tribal and urban Indian health clinical 

settings. The report’s five recommendations are based on the best available clinical evidence 

regarding the prevention and treatment of childhood overweight. (December 2008).

9. Other Organizations, Programs, and Resources.

• American Association of Diabetes Educators

www.diabeteseducator.org/

• American Diabetes Association

www.diabetes.org

• Centers for Disease Control and Prevention Division of Diabetes Translation

http://www.cdc.gov/diabetes/

• MedlinePlus for diabetes information

www.nlm.nih.gov/medlineplus/diabetes.html

• National Diabetes Education Program

http://ndep.nih.gov/

• National Institute of Diabetes and Digestive and Kidney Diseases

http://www2.niddk.nih.gov/

• National Kidney Foundation

http://www.kidney.org/

• TrailBlazer Health Enterprises, LLC (a CMS-contracted intermediary and 

carrier)

www.trailblazerhealth.com
Appendix G: Glossary

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 74

Appendix G: Glossary

ADA Nutrition Practice Guidelines and Models 

A systematic problem-solving method professionals use to think critically and make decisions 

to address nutrition-related problems and provide safe, effective, high quality nutrition care.

Note: The ADA now uses the preferred term, “Nutrition Care Processes.” 

Accept Assignment

An agreement among Medicare, health care providers, and suppliers of health care equipment 

and supplies. Accepting assignment means the providers or suppliers agree: (1) to receive 

direct payment from Medicare; and (2) to accept the Medicare-approved amount as payment 

in full for the service. The health care provider cannot collect additional fees for the service.

All-Inclusive Rate

See definition for “IHS All-Inclusive Rate.”

Beneficiary

The person who has health insurance through Medicare or Medicaid. 

Bill

See definition for “Claim.”

Claim

A request for payment for a provided service. The terms “claim” and “bill” are used for 

Medicare Part A inpatient services (submitted to CMS fiscal intermediaries) and Medicare Part 

B outpatient services (submitted to CMS carriers).

CMS: Centers for Medicare and Medicaid Services 

The U.S. Federal government agency that administers Medicare, Medicaid, and the State 

Children’s Health Insurance Program (SCHIP).

CMS Form 1500

The form, or electronic equivalent, that health care providers use to submit bills to Medicare 

Part B carriers and other insurance companies.

CMS Form 1450 (also called UB92)

The form, or electronic equivalent, that health care providers use to submit bills to Medicare 

Part A fiscal intermediaries, primarily for Medicare Part A services, and some Part B services.

CPT Codes (Current Procedural Terminology Codes)

Codes used to communicate to payers the procedures performed during the patient visit. The 

Medical Nutrition Therapy CPT codes are unique codes that describe MNT services provided by 

nutrition professionals. The CMS requires use of these codes in reimbursement documentation 

of MNT services for patients with diabetes, non-dialysis kidney disease, or post-kidney 

transplant. 

Distant Site

The site at which the practitioner delivering the service is located at the time the service is 

provided via a telecommunications system.
Appendix G: Glossary

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 75

DSMT: Diabetes Self-Management Training

An interactive and collaborative process that involves the person with diabetes and the 

diabetes educator. This process includes: (1) assessment ofthe individual’s specific education 

needs; (2) identification of the individual’s specific diabetes self-management goals; (3) 

education and behavioral intervention directed toward helping the individual achieve selfmanagement goals; and (4) evaluation of the individual’s progress toward self-management 

goals. You must be an IHS, American Association of Diabetes Educators, or American Diabetes 

Association accredited diabetes education program to receive Medicare reimbursement for 

DMST. For more information on Medicare reimbursement for DMST, please refer to Appendix 

A.

Note: DSMT also is known as DSME, or Diabetes Self-Management Education. Although DSME is 

the preferred term, the CMS requires the use of DSMT in reimbursement documentation.

EHR (Electronic Health Record)

A longitudinal collection of electronic health information about individual patients or 

populations. Also known as an electronic patient record or computerized patient record.

End Stage Kidney Disease

The complete or near complete failure of the kidneys to function to excrete wastes, 

concentrate urine, and regulate electrolytes. 

Note: End stage kidney disease also is known as end stage renal disease (ESRD).

Episode of Care 

The care provided during one calendar year (January 1 through December 31).

FQHC (Federally Qualified Health Centers)

Facilities or programs more commonly known as Community Health Centers, Migrant Health 

Centers, and Health Care for the Homeless Programs. A FQHC includes an outpatient program 

or facility operated by a Tribe or Tribal organization under the Indian Self-Determination Act 

(PL 93-638) or an urban Indian organization receiving funds under Title V of the Indian Health 

Care Improvement Act as of October 1, 1991.

G Codes

Codes for Medicare-covered MNT services, when additional hours of MNT services are 

performed beyond the number of hours typically covered (3 hours in the initial calendar year 

and 2 follow-up hours in subsequent years with a physician referral) when the treating 

physician determines there is a change of diagnosis or medical condition that makes a change 

in diet necessary. 

HCPCS (Healthcare Common Procedure Coding System)

A set of health care procedure codes based on the American Medical Association Current 

Procedural Terminology (CPT). Commonly pronounced Hick-Picks.

HIPAA (The Health Insurance Portability and Accountability Act)

The Act mandates the standards to use for the electronic exchange of health care data; what 

medical and administrative code sets should be used within those standards; the use of 

national identification systems for health care patients, providers, payers (or plans), and 

employers (or sponsors); and the types of measures required to protect the security and 

privacy of personally identifiable health care information.
Appendix G: Glossary

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 76

HPSA (Health Professional Shortage Area)

A geographic area, population group, or health care facility designated by the Federal 

government as having a shortage of health professionals.

ICD-9 Codes (International Classification of Diseases, 9th Revision, Clinical 

Modifications)

Diagnostic codes used in hospital inpatient medical records. Also used on claims processing 

forms in hospital outpatient settings, physician offices, and RD practices.

IHS All-Inclusive Rate

The rate negotiated by the IHS for services provided under Medicare Part A. The IHS 

renegotiates this rate with the Office of Management and Budget (OMB) each year, so the rate 

may vary from year to year.

Medicaid

A health care program, sponsored by the Federal government and State governments, which 

pays for medical care for those who cannot afford it. The program typically helps low-income 

individuals or families, as well as elderly or disabled individuals. To receive Medicaid, an 

individual must meet certain requirements (such as income level). Although all States 

participate in the Medicaid program, each State manages its own program and sets different 

requirements and other guidelines.

Medicare

The Federal government’s health insurance program for people 65 years of age or older, 

certain younger people with disabilities, and people with end stage kidney disease (i.e., 

patients with permanent kidney failure who need regular dialysis or a kidney transplant).

Medicare Carrier

A private company that contracts with Medicare to process Medicare Part B bills.

Medicare Fiscal Intermediary

A private company that has a contract with Medicare to pay Part A and some Part B bills. Also 

called an intermediary.

Medicare Part A (Facility/Hospital Insurance)

Medicare hospital insurance that pays for inpatient hospital stays, hospice care, home health 

care, and care in a skilled nursing facility. MNT or other nutrition services are not a separately 

reimbursed service under Medicare Part A coverage. Instead, these services are included in 

the room and board services covered under Medicare Part A. The fiscal intermediary uses the 

IHS All-Inclusive Rate to reimburse services provided to patients who have Medicare Part A 

coverage (see definition for “IHS All-Inclusive Rate”). 

Medicare Part B (Professional Provider Medical Insurance)

Medicare medical insurance that helps pay for physicians’ services, outpatient hospital care, 

and other medical services that are not covered by Medicare Part A. The carrier uses the 

physician fee schedule to reimburse for Medicare Part B services (see definition for “Physician 

Fee Schedule”).
Appendix G: Glossary

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 77

Medicare Secondary Payer

Any situation when another payer or insurer pays a beneficiary’s medical bills before Medicare 

pays any medical bills. For example, a Medicare secondary payer may pay the first 85% of the 

bill, and Medicare will pay the remaining 15% of the bill. 

Note: “Payer” is also spelled as “payor.”

MNT: Medical Nutrition Therapy 

A specific application of the Nutrition Care Process in clinical settings focused on management 

of diseases. MNT involves in-depth nutrition assessment and a duration and frequency of care 

using the Nutrition Care Process to manage disease. MNT services are defined in the Federal 

(Medicare Part B) statute as “nutritional diagnostic, therapy, and counseling services for the 

purpose of disease management, furnished by a registered dietitian or nutrition 

professional...pursuant to a referral by a physician.” MNT is provided by licensed/certified (as 

applicable) registered dietitians and nutrition professionals.

Nutrition Care Process and Model 

The framework for the critical thinking process used by dietetics professionals as they provide 

nutrition services to their clients/patients, and comprised of four steps: Nutrition Assessment, 

Nutrition Diagnosis, Nutrition Intervention, and Nutrition Monitoring and Evaluation. 

NPI: National Provider Identifier 

A standard, unique identifier for health care providers used when filing and processing health 

care claims and other transactions. 

Nutrition Provider

A registered dietitian or nutrition professional as defined by the Medicare MNT statute. 

Payment Rate

The total payment that a hospital or community mental health center receives when it 

provides outpatient services to Medicare patients. 

PCC (Patient Care Component)

A form used in IHS to document clinical care.

Physician Fee Schedule

The payment rates for MNT services under Medicare Part B. The Medicare Part B MNT payment 

is 80% (because a 20% patient co-pay applies) of the lesser of either the actual charge or 80% 

of the physician fee schedule amount. The physician fee schedule varies by State. 

Private Insurance

Private insurance is insurance provided through an entity either for profit or not-for- profit and 

other than the Federal government or a State government.

Provider

A hospital, a health care professional, or a health care facility.

Real Time Video Conferencing/Communication

Reimbursement for Medicare Telehealth services requires the RD to use an interactive audio 

and video telecommunications system permitting real-time communication between the 
Appendix G: Glossary

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 78

distant site (where the RD is located) and the originating site (where the beneficiary/patient is 

located). 

Registered Dietitian (RD)

A health professional with a bachelor’s degree or higher in nutrition or dietetics who meets 

certification or registration requirements.

Rural Health Clinics (RHCs) 

Clinics located in areas designated by the Bureau of Census as rural and by the Secretary of 

the DHHS as medically underserved, or underserved, or having an insufficient number of 

physicians and meet the requirements under 42 CFR 491.

Superbill

A pre-printed form that itemizes and describes all services and fees.

Telehealth

The use of health information exchanged from one site to another via electronic 

communications to improve a patient's health. Electronic communication means the use of 

interactive telecommunications equipment that includes, at a minimum, audio and video 

equipment permitting two-way, real time interactive communication between the patient and 

the physician or practitioner at the distant site. 

TrailBlazer Health Enterprises, LLC

A CMS-contracted intermediary and carrier. For more information, visit the website at: 

www.trailblazerhealth.com. 

UB92

See definition for “CMS Form 1450.”
Appendix H: References

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 79

Appendix H: References

American Dietetic Association Evidence Analysis Library. Diabetes type 1 and 2 evidence-based 

nutrition practice guidelines for adults: executive summary of recommendations. Chicago, IL: 

American Dietetic Association, 2010.

American Dietetic Association. International dietetics & nutrition terminology (IDNT) reference 

manual: standardized language for the nutrition care process, second edition. Chicago, IL: 

American Dietetic Association, 2008.

American Dietetic Association. Position of the American Dietetic Association: Costeffectiveness of medical nutrition therapy. Journal of the American Dietetic Association. 

1995; 95:88-91.

American Dietetic Association. Diabetes white paper – defining the delivery of nutrition 

services in Medicare Medical Nutrition Therapy vs. Medicare Diabetes Self-Management training 

programs. Chicago, IL: American Dietetic Association, 2008. 

Bantle J, Wylie-Rosett J, Albright A, Apovian C, Clark N, Franz M, Hoogwerf B, Lichtenstein A, 

Mayer-Davis E, Mooradian A, Wheeler ML. Nutrition recommendations and interventions for 

diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008; 

31(Suppl. 1):S61-S78.

Brown TL, Lahi S, Sipe M, Travis L, Phillips D, Valdez L, Broussard B. The Medicare medical 

nutrition therapy benefit: A first step guide for I/T/U health care facilities. IHS Primary Care 

Provider. 2002; 27(6):119-29.

Centers for Medicare and Medicaid Services. Medicare benefit policy manual. Available at the 

website: http://www.cms.hhs.gov/manuals/iom/List.asp. Accessed February 2010.

(Click on “Regulations and Guidance”, click on “Manuals” under “Guidance”, click on 

“Internet-Only Manuals” under the “Manuals” sidebar, and select “100-02” for the Medicare 

Benefit Policy Manual.) 

Centers for Medicare and Medicaid Services. MNT services for beneficiaries with diabetes or 

renal disease-correction, CMS transmittal A-03-009. Available at the website: 

http://new.cms.hhs.gov/Transmittals/downloads/A03009.pdf. Accessed February 2010. 

Diabetes Prevention Research Group. Reduction in the evidence of type 2 diabetes with 

lifestyle intervention or metformin. New England Journal of Medicine. 2002; 346:393-403.

Franz M, Boucher J, Green-Pastors J, Powers M. Evidence-based nutrition practice guidelines 

for diabetes and scope and standards of practice. Journal of the American Dietetic 

Association. 2008; 108 (4 Suppl 1):S52-58.

Franz M, Monk A, Barry B, McClain K, Weaver T, Cooper N, Upham P, Bergenstal R, Mazze R. 

Effectiveness of medical nutrition therapy provided by dietitian in the management of noninsulin-dependent diabetes mellitus: A randomized, controlled clinical trial. Journal of the 

American Dietetic Association. 1995; 95:1009-17.
Appendix H: References

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 80

Johnson, R. The Lewin Group Study – What does it tell us and why does it matter? Journal of 

the American Dietetic Association. 1999; 99:426-27.

Kulkarni K, Boucher JL, Daly A, Shwide-Slavin C, Silvers BT, O'Sullivan Maillet J, Pritchett E. 

American Dietetic Association: Standards of practice and standards of professional 

performance for registered dietitians (generalist, specialty, and advanced) in diabetes care. 

Journal of the American Dietetic Association. 2005; 105(5):819-24. 

Morris S, Wylie-Rosett J. Medical nutrition therapy: a key to diabetes management and 

prevention. Clinical Diabetes. 2010; 28(1):12-18. 

http://clinical.diabetesjournals.org/content/28/1/12.full.pdf+html. Accessed February 2010.

Nutrition Care Process and Model Part I: The 2008 Update. Journal of the American Dietetic 

Association. 2008; 108(7):1113-17.

Nutrition Care Process Part II: Using the International Dietetics and Nutrition Terminology to 

Document the Nutrition Care Process. Journal of the American Dietetic Association. 

2008;108(8):1287-93.

Pastors J, Franz MJ, Warshaw H, Daly A, Arnold MS. How effective is medical nutrition therapy 

in diabetes care? Journal of the American Dietetic Association. 2003; 103 (7):827l-831.

Sandoval WS, Brown T, Broussard B. Medical nutrition therapy works, saves money and makes 

money, Part 1: Increasing access to nutrition services. IHS Primary Care Provider. 2007; 

32(3):65-68. 

Sandoval WS, Butler C, Broussard B, Brown T. Medical nutrition therapy works, saves money 

and makes money, Part 2: maximizing medical nutrition therapy reimbursement. IHS Primary 

Care Provider. 2007; 32(10):297-303.

Shields JF, Rubin R, and Stapleton DC. The estimated costs and savings of medical nutrition 

therapy: The Medicare population. Journal of the American Dietetic Association. 1999; 

99:426-27.

White J, Ayoob K, Benedict M et al. Registered dietitians’ coding practices and patterns of 

code use. Journal of the American Dietetic Association. 2008; 108(7):1242-8.

Wilson C, Brown T, Gilliland S, Acton K. Effects of clinical nutrition education and educator 

discipline on glycemic control outcomes in the Indian Health Service. Diabetes Care. 2003;

26:2500-04. 
Acknowledgements

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 81

Acknowledgements

Thank you to everyone who helped to write and review the Step-by-Step Guide to Medical 

Nutrition Therapy Reimbursement. Your expertise and insights have been invaluable for 

producing this 2nd edition of the guide.

Writers:

CAPT Tammy L. Brown, MPH, RD, BC-ADM, CDE

Nutrition Consultant, IHS Division of Diabetes Treatment and Prevention, Albuquerque, NM

Cecilia Butler, MS, RD, CDE

Clinical Dietitian and Diabetes Program Coordinator, Santa Fe Indian Hospital, Santa Fe, NM

LCDR Susan Jones, MS, RD, LD, CNSD

Senior Clinical Dietitian, IHS Northern Navajo Medical Center, Shiprock, NM

CDR Sandra Lahi, MBA, RHIA, CPC

Business Office Coordinator, Oklahoma City Area IHS, Oklahoma City, OK

LCDR Diane Phillips, RD, LD, CDE 

Program Director, IHS Telenutrition Program, Flagstaff, AZ

CDR Leslye Rauth, MPH, RD, CDE

Clinical Applications Coordinator, IHS Office of Information Technology, IHS Headquarters

Jimmie Strock, MS, RD (Retired)

Supervisory Dietitian, IHS Sells Service Unit, Sells, AZ

Sara Lee Thomas, MS, RD

Public Health Nutritionist and Cholesterol Coordinator, Warm Springs Service Unit, Warm 

Springs, OR

CAPT Leeanna Travis, MS, MA, RD, CDE 

Director, Food and Nutrition Services, IHS Santa Fe Service Unit, Santa Fe, NM 

Reviewers and Contributors:

CAPT Kelly Acton, MD, MPH, FACP

Director, IHS Division of Diabetes Treatment and Prevention, Albuquerque, NM

LT Dolores G. Addison, RD

Senior Assistant Dietitian, IHS Sells Service Unit, Sells, AZ

CDR Adam T. Archuleta, MPH

Director, Revenue Enhancement Services, Tucson Area IHS, Tucson, AZ

CAPT Karen Bachman-Carter, MPH, RD

Nutrition Consultant, IHS Navajo Area Diabetes Program, Shiprock, NM
Acknowledgements

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 82

Kari Blasius, RD, LN, CDE

Dietitian, IHS Fort Thompson Health Center, Fort Thompson, SD

Roslyn (Roz) Bolzer, RD, LN

Diabetes Coordinator/Dietitian, IHS Kyle Health Clinic, Kyle, SD

Brenda Broussard, MPH, MBA, RD, CDE, BC-ADM

Nutrition Consultant, The Hill Group, Albuquerque, NM

CAPT Edith Clark, MBA, RD, CDE

Director, Nutrition Services and Director, IHS Southwestern Dietetic Internship Consortium, 

Phoenix Indian Medical Center, Phoenix, AZ

Lindsey Cometa

Health Insurance Specialist, Tribal Affairs Group/Office of External Affairs,

Centers for Medicare and Medicaid Services, Baltimore, MD

Darcy de la Rosa, MPH, RD/LD, CDE

Diabetes Case Manager, Confederated Tribes of Siletz Community Health Center, Siletz, OR

Rachel Greenberg, MA

Health Communications Consultant, the Hill Group, Bethesda, MD

Terri Harris, MBA

Health Insurance Specialist, Center for Medicare Management, Centers for Medicare and 

Medicaid Services, Baltimore, MD

Renée Hildt 

Health Insurance Specialist, Center for Medicare Management, Centers for Medicare and 

Medicaid Services, Baltimore, MD

LT Michelle Johnson, MS, RD, LD

Outpatient Dietitian, IHS Chinle Comprehensive Healthcare Facility, Chinle, AZ

Sandra Jones

Specialist, Office of Clinical Standards and Quality, Centers for Medicare and Medicaid 

Services, 

Baltimore, MD

CDR Susan Jordan, MS, RD, CDE

Supervisory Dietitian, IHS Crow Northern Cheyenne Hospital, Crow Agency, MT

Theresa Kuracina, MS, RD, CDE 

Dietitian, IHS Albuquerque Indian Health Center, Albuquerque, NM

Donna Laat, CPC

Medical Assistant, IHS Santa Fe Service Unit, Santa Fe, NM

Mildred Lincoln, RD

Dietitian, IHS Gallup Indian Medical Center, Gallup, NM
Acknowledgements

Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement, 2nd Edition 83

Lisa Martin, MS, RD, CDE

Nutritionist/Diabetes Coordinator, IHS Catawba Service Unit, Rock Hill, SC

Stefanie McLain, MS, RD, LD

Community Health Department Dietitian, IHS Wewoka Service Unit, Wewoka, OK

Pam Michael, MBA, RD

Director, Nutrition Services Coverage Team, American Dietetic Association, Chicago, IL

Joan Moliki

Health Insurance Specialist, Office of Clinical Standards and Quality, Centers for Medicare and 

Medicaid Services, Baltimore, MD

Leonard Montoya 

Administrative Officer, IHS Santa Fe Service Unit, Santa Fe, NM

Sandra Poitra, RD

Community Dietitian, IHS Turtle Mountain Comprehensive Health Center,

Belcourt, ND

LCDR John E. Rael, MBA, BBA

Management and Program Analyst, IHS Office of Resource Access and Partnerships, Division of 

Business Office Enhancement, Albuquerque, NM

Jody Rosendahl, RD

Supervisory Dietitian, IHS Turtle Mountain Comprehensive Healthcare Center, Belcourt, ND

Cathie Rowland-Robert

Health Insurance Specialist, Centers for Medicare and Medicaid Services, Washington, DC

LCDR Revondolyn (Faye) Scott, RD

Public Health Nutritionist, IHS Chinle Service Unit, Piñon, AZ

Patricia Sheely, RD, CDE

Dietitian, IHS Gallup Indian Medical Center, Gallup, NM

Frances Silva, CPC

Medical Assistant, IHS Santa Fe Service Unit, Santa Fe, NM

CAPT Melanie Sipe, RD, CDE

Dietitian and Program Director, IHS Claremore Service Unit Diabetes Program, Claremore, OK

Karen Trujillo, CPC

Medical Clerk, IHS Santa Fe Service Unit, Santa Fe, NM

LT Kelli Wilson, MS, RD, LD

Public Health Nutritionist; Director, Community Health and Diabetes Programs

IHS Wewoka Service Unit, Wewoka, OK
Step-by-Step Guide to Medicare Medical 

Nutrition Therapy

Reimbursement, 2nd Edition, April 2010

Indian Health Service

Division of Diabetes Treatment and Prevention

Albuquerque, New Mexico

www.diabetes.ihs.gov