(Medicare Claims Processing Manual)

NOTE: Additional covered hours of MNT services may be covered beyond the number of hours typically covered under an episode of care when the physician determines there is a change of diagnosis or medical condition within such episode of care that makes a change in diet necessary. Appropriate medical review for this provision should only be done on a post payment basis. Outliers may be judged against nationally accepted dietary or nutritional protocols in accordance with 42 CFR 410.132 (a).   300.3 - Dietitians and Nutritionists Performing MNT Services  (Rev. 11426; Issued: 05- 20-22; Effective: 01 -01-22; Implementation: 07 -05-22)   A. Professional Standards for Dietitians and Nutritionists   For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional may provide the services. Registered dietitian or nutrition professional means a dietitian or nutritionist licensed or certified in a state as of December 21, 2000 (they are not required to meet any other requirements); or an individual whom, on or after December 22, 2000:    Holds a bachelors or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics, as accredited by an appropriate national accreditation organization recognized for this purpose. The academic requirements of a nutrition or dietetics program may be completed after the completion of the degree;    Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional. Documentation of the supervised dietetics practice may be in the form of a signed document by the professional/fa cility that supervised the individual; and,    Is licensed or certified as a dietitian or nutrition professional by the state in which the services are performed. In a state that does not provide for licensure or certification, the individual will be deemed to have met this requirement if he or she i s recognized as a registered dietitian by the Commission on Dietetic Registration or its successor organization, or meets the requirements stated above.   B. Enrollment of Dietitians and Nutritionists    In order to file claims for MNT, a registered dietitian/nutrition professional must be enrolled as a provider in the Medicare program and meet the requirements outlined above. MNT services can be billed with the effective date of the providers license and the establishment of the practice location.    The A/B MAC (B) shall establish a permanent NPI for any new registered dietitian or nutrition professional who is applying to become a Medicare provider for MNT.    Registered dietitians and nutrition professionals must accept assignment. Since these new providers must accept assignment, the limiting charge does not apply.   300.4 - Payment for MNT Services (Rev. 11426; Issued: 05- 20-22; Effective: 01 -01-22; Implementation: 07 -05-22)  The contractor shall pay for MNT services under the physician fee schedule for dates of service on or after January 1, 2002, to a registered dietitian or nutrition professional that meets the above requirements. Deductible and coinsurance apply. As with th e DSMT benefit, payment is only made for MNT services actually attended by the beneficiary and documented by the provider, and for beneficiaries that are not inpatients of a hospital or skilled nursing facility.   The contractor shall pay the lesser of the actual charge, or 85% of the physician fee schedule amount when rendered by a registered dietitian or nutrition professional. As required by statute, use this same methodology for services provided in the hospital  outpatient department.   A. Payable Codes for MNT with Applicable Instructions    97802 -  Medical nutrition therapy; initial assessment and intervention, individual, face -to-face with the patient, each 15 minutes. ( NOTE: This HCPCS code must only be used for the initial visit.)   This code is to be used only once for the initial assessment of a new patient. The provider shall bill all subsequent individual visits (including reassessments and interventions) as 97803. The provider shall bill all subsequent group visits as 97804.    97803 -  Re-assessment and intervention, individual, face -to-face with the patient, each 15 minutes   The provider shall bill this code for all reassessments and all interventions after the initial visit (see 97802). This code should also be used when there is a change in the patients medical condition that affects the nutritional status of the patient (s ee the heading, Additional Covered Hours for Reassessments and Interventions).    97804 -  Group (2 or more individual(s)), each 30 minutes   The provider shall bill this code for group visits, initial and subsequent. This code can also be used when there is a change in a patients condition that affects the nutritional status of the patient and the patient is attending in a group.   NOTE: The above codes can be paid if submitted by a registered dietitian or nutrition professional who meet the specified requirements; or a hospital that has received reassigned benefits from a registered dietitian or nutritionist. These services cannot be paid incident to physician services.   B. Healthcare Common Procedure Coding System (HCPCS) Codes for MNT When There is a Change in the Beneficiaries Condition (for services effective on or after January 1, 2003)   The following HCPCS codes shall be used when there is a change in the beneficiary's condition:    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 to face with the patient, each 15 minutes.    G0271 -  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) group (2 or more individuals), each 30 minutes.   NOTE: These G codes should be used 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 physician de termines there is a change of diagnosis or medical condition that makes a change in diet necessary. Appropriate medical review for this provision should only be done on a post payment basis. Outliers may be judged against nationally accepted dietary or nut ritional protocols in accordance with 42 CFR 410.132(a).   300.5 - General Claims Processing Information  (Rev.11504, Issued 07- 21-22; Effective:01 -10-23; Implementation: 01 -03-23)  This benefit is payable for beneficiaries who have diabetes or renal disease.  Contractors are urged to perform data analysis of these services in your jurisdiction.  If you determine that a potential problem exists, you should verify the cause of the pote ntial error by conducting an error validation review as described in the Program Integrity Manual (PIM), Chapter 3, Section 2A.  Where errors are verified, initiate appropriate corrective actions found in the PIM, Chapter 3, Sections 3 through 6.  If no di agnosis is on the claim, return the claim as unprocessable.  If the claim does not contain a diagnosis of diabetes or renal disease, then deny the claim under Section 1862(a)(1)(A) of the Act.   A. Special Requirements for A/B MACs (B)    Registered dietitians and nutrition professionals can be part of a group practice in which case the provider identification number of the registered dietitian or nutrition professional that performed the service must be entered in on the claim form.    The specialty code for dietitians/nutritionists is 71.   B. Medicare Summary Notices (MSNs)    Use the following MNT messages where appropriate.  If you locate a more appropriate message, then you should use it.   If a claim for MNT is submitted with dates of service before January 1, 2002, use MSN 21.11 (This service was not covered by Medicare at the time you received it).  The Spanish version is Este servicio no estaba cubierto por Medicare cuando usted lo recibio.    If a claim for MNT is submitted by a provider that does not meet the criteria use MSN 21.18 (This item or service is not covered when performed or ordered by this provider).  The Spanish version is Este servicio no esta cubierto cuando es ordenado o rendido por este proveedor.   C. A/B MAC (A)  Special Billing Instructions   MNT Services can be billed to A/B MACs (A) when performed in an outpatient hospital setting.  The Hospital outpatient departments can bill for the MNT services through the A/B MAC (A) if the nutritionists or registered dietitians reassign their benefits to the hospital.  If the hospitals do not get the reassignments the nutritionists and the registered dietitians will have to bill the Medicare A/B MAC (B) under their own provider number  or the hospital will have to bill the Medicare A/B MAC (B).   NOTE:   Nutritionists and registered dietitians must obtain a Medicare provider number before they can reassign their benefits.   The only applicable bill types are 13X, 23X, 32X, and 85X.      300.5.1 - Rural Health Centers (RHCs)/Federally Qualified Health Centers (FQHCs) Special Billing Instructions  (Rev. 11426; Issued: 05- 20-22; Effective: 01 -01-22; Implementation: 07 -05-22)  Detailed billing instructions for MNT services provided in Rural Health Clinics and Federally Qualified Health Centers can be found in Chapter 9, section 182 of this manual.   300.6 - Common Working File (CWF) Edits  (Rev. 11426; Issued: 05- 20-22; Effective: 01 -01-22; Implementation: 07 -05-22)  The Common Working File (CWF) edit will allow 3 hours of therapy for MNT in the initial calendar year. The edit will allow more than 3 hours of therapy if there is a change in the beneficiarys medical condition, diagnosis, or treatment regimen and this change must be documented in the beneficiarys medical record. Two new G codes have been created for use when a beneficiary receives a second referral in a calendar year that allows the beneficiary to receive more than 3 hours of therapy. Another edit will a llow 2 hours of follow up MNT with another referral in subsequent years.   Advance Beneficiary Notice (ABN)   The beneficiary is liable for services denied over the limited number of hours with referrals for MNT. An Advance Beneficiary Notice (ABN) should be issued in these situations. In absence of evidence of a valid ABN, the provider will be held liable.   An ABN should not be issued for Medicare -covered services such as those provided by hospital dietitians or nutrition professionals who are qualified to render the service in their state but who have not obtained Medicare provider numbers.   Duplicate Edits   Although beneficiaries are allowed to receive training and therapy during the same time period DSMT and MNT services may not be provided on the same day to the same beneficiary. Effective April 1, 2010 CWF shall implement a new duplicate crossover edit to identify and prevent claims for DSMT/MNT services from being billed with the same dates of services for the same beneficiaries submitted from institutional providers and from a professional provider.   310 - Lung Volume Reduction Surgery  (Rev. 768, Issued:  12- 01-05; Effective:  11 -17-05; Implementation:  03 -02 06)   Lung Volume Reduction Surgery (LVRS) (also known as reduction pneumoplasty, lung shaving, or lung contouring) is an invasive surgical procedure to reduce the volume of a hyperinflated lung in order to allow the underlying compressed lung to expand, and thus, establish improved respiratory function.   Effective for 'from' dates of service on or after January 1, 2004, Medicare will cover LVRS under certain conditions as described in 240 of the Pub. 100- 03, National Coverage Determinations.   LVRS can only be performed in the facilities listed on the following website:  http://www.cms.gov/Medicare/Medicare -General -Information/MedicareApprovedFacilitie/Lung -Volume -Reduction- Surgery -LVRS.html .   LVRS is an inpatient procedure.  However pre - and post - operative services are performed on an outpatient basis and must be performed at one of the facilities certified to do so.  These procedures are paid under the Outpatient Prospective Payment System (OPPS), except for hospitals located in Maryland.   Medicare previously only covered LVRS as part of the National Emphysema Treatment Trial (NETT).  The study was limited to 18 hospitals, and patients were randomized into two arms, either medical management and LVRS or medical management.  The study was con ducted by The National Heart, Lung, and Blood Institute of the National Institutes of Health and coordinated by Johns Hopkins University (JHU).  Hospital claims for patients in the NETT were identified by the presence of Condition Code EY.  The JHU instruc ted hospitals of the correct billing procedures for billing claims under the NETT.