Unlock the Secrets of Dietitian Billing: Master CPT Codes Like a Pro!

For dietitians and nutritionists, understanding Current Procedural Terminology (CPT) codes is crucial for accurate billing and reimbursement. This article provides a detailed overview of CPT codes relevant to nutrition counseling, including common codes, billing procedures, and helpful tips for navigating the insurance landscape.

Understanding CPT Codes

CPT codes are used to classify medical services and procedures for billing and reporting. These codes provide a uniform shorthand, so that everyone from healthcare providers to insurance companies, can easily speak the same language. This keeps everything streamlined while improving accuracy and efficiency. The American Medical Association (AMA) establishes and reviews these codes annually. They are widely accepted by private insurance companies, Medicare, and Medicaid, helping to streamline insurance billing, improve coding accuracy, and facilitate efficient claim processing. All nutritionist CPT codes and dietary counseling CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. These standardized codes create a universal language across the healthcare ecosystem, enabling collaboration among providers and ensuring clarity in billing and documentation.

CPT Codes vs. ICD Codes

It's important to distinguish between CPT and ICD codes. While CPT codes describe the services provided (e.g., nutrition counseling), ICD codes identify a patient’s diagnosis or medical condition. When submitting an insurance claim, both CPT and ICD codes are included. CPT codes indicate the specific services performed, while ICD codes provide a justification for why the service was necessary by documenting a medical condition. For example, E11.9 for diabetes.

Common CPT Codes for Dietitians

Most health insurance companies accept the same three CPT codes 97802, 97803, and 97804. When billing for nutrition counseling services, dietitians and nutritionists most commonly use CPT code 97802 and CPT code 97803. These codes are essential for medical nutrition therapy and ensure reimbursement from insurance payers, including private insurers, Medicare, and Medicaid. The MNT codes, CPT 97802, 97803 and 97804 are the most common procedure codes used to bill for nutrition counseling.

97802: Initial Assessment for Medical Nutrition Therapy (MNT)

Read also: Pediatric Dietitian Services

This code is used for an initial assessment for medical nutrition therapy. This code is specifically for face-to-face nutrition counseling, lasting 15 minutes per unit. The difference between 97802 and 97803 is that you can only bill using CPT code 97802 once for an initial MNT patient visit with you. Please note that if your patient has seen a different dietitian and this is their first visit with you - then you can still use CPT code 97802. As this is the patient’s initial visit with YOU.
97803: Follow-Up Nutrition Counseling Sessions
You will use CPT code 97803 for all MNT nutrition visits beyond the initial visit. This code is used for follow-up nutrition counseling sessions. This code is specifically used for face-to-face reassessment or intervention, also lasting 15 minutes per unit.
97804: Group Nutrition Counseling
CPT code 97804 would be used to bill for groups of patients of two or more. In addition, CPT code 97804 is used for group nutrition counseling sessions (2 or more individuals) and is billed in 30 minute increments.

Read also: RD Credential Information

Billing Procedures and Claim Submission

When billing a patient’s health insurance for MNT will always use a CMS 1500 form. Accurately billing CPT codes for nutrition services is crucial for insurance reimbursement. When submitting a claim, providers must specify the number of units and the fee per unit to ensure proper processing. If billing on a CMS1500 form, the CPT code goes in box 24D.

Understanding Units

It’s important to ensure that you’re not just submitting the correct code, but also including the accurate number of units for each code as this will drastically affect your reimbursement. CPT code 97802 (initial assessment) and CPT code 97803 (follow-up visits) are unit-based. The units represent time blocks of 15 minutes. So, in the example above, 6 units would equal 90 minutes of face-face MNT counseling.

One unit = 15 minutes of service.
Four units = 60 minutes
Six units = 90 minutes per session.

Many private insurance payers allow up to six units per visit when billing 97802 CPT code for an initial assessment.

CMS 1500 Claim Form

The CMS 1500 form is used by private practice dietitians and nutrition professionals to submit insurance claims. Originally developed by Medicare, it is now widely accepted by private insurance payers as well. While CMS 1500 forms are still available in paper format, most claims are now submitted electronically. For billing, I use the clearing house Office Ally. It used to be free. However, now many of the insurance companies I file claims for don’t participate with Office Ally, so I pay $70.00 per month to use the service. On the CMS 1500 Claim Form, you put the CPT code in section 24. location D. We refer to this section as the ‘Procedures, Services, or Supplies,’ area of the claim. The example in the image above represents a claim for an initial MNT assessment with the corresponding CPT code 97803.

Steps for filling out a CMS 1500 form:

Locate field 24D-”Procedures, Services, or Supplies”: This is where you can enter CPT code 97802 or CPT code 97803.
Enter only one CPT code per line: If multiple services were provided, list them on separate lines. Note that a visit can only qualify for code 97802 or code 97803, not both.
Specify the number of units: Ensure that your time-based units match the duration of service provided.
Verify the ICD-10 Diagnosis code: While the CPT code describes the service, the ICD-10 code justifies the need for treatment.
Double-check codes and insurance information: Review and verify the claim is filled out accurately before submitting to reduce claim denials.

Electronic Billing Platforms

Manually filing out CMS 1500 forms and submitting claims can be both time-consuming and more likely to incur errors. Using a digital EHR and billing platform, such as Healthie, can streamline this process and reduce administrative burden. Luckily in Office Ally you can set up templates to use. For example, for each of the dietitians in my group, I have templates set up for an initial visit (97802) and a follow-up visit (97803). That way each time we bill for a patient we only need to click on the patient’s name, the type of visit and the date billed.

Read also: Your Guide to Dietitians

With Healthie’s integrated billing system, you can:

Easily select CPT codes: The Healthie platform was built for nutritionists and dietitians, and allows clinicians to easily choose CPT codes to add to claims.
Automate claim generation: Healthie’s all-in-one EHR, practice management, and patient engagement platform can autopopulate form fields, reducing manual errors.
Set units and fees: Enter the number of billed units per session, and Healthie can calculate charges automatically.
Minimize errors with claim scrubbing: Healthie integrates with clearinghouses such as ClaimMD and OfficeAlly, allowing you to send claims more easily to insurance payers.

Superbills

If you don’t yet have an MNT Superbill to use for your nutrition private practice please feel free to use the one I created for my practice. You should provide an MNT Superbill to your patients whose insurance companies you don’t participate with. Or put another way - for insurance companies you are considered an out of network provider. The patient pays you first and THEN you provide the MNT Superbill. Think of a Superbill just like a receipt. The patient then submits the Superbill to their insurance company in an effort to collect reimbursement. The patient’s particular insurance policy will dictate whether or not they will be reimbursed for their visit. On the MNT Superbill I created you can easily edit the fields in Word. Depending upon the nature of the visit (initial or follow-up visit) you would write the appropriate CPT code and include a brief description of the CPT code. When you are an out network provider insurance rates don’t apply to you. Therefore, you can use your personal established rates. Make sure to note the amount charged, the amount paid and whether or not there is a balance. A good rule of business with MNT Superbills is to collect all money up front - either charge the patient before their visit or no later than at the of service.

Additional CPT and HCPCS Codes

While the MNT codes (97802, 97803, and 97804) are the most common, dietitians may encounter other codes. It can be tempting to bill for a service that pays out well, but it is important that providers bill correctly and with integrity. Your contract with the health insurance company should list all the procedure codes you can bill with. Make sure you truly understand what the code means and what is required to fulfill the definition. There is, unfortunately, a lot of misinformation spread between dietitians regarding coding and billing. Remember that dietitians are trained to be experts in food and nutrition, not in reimbursement. Even if you are personally getting paid for different codes, realize that insurance companies can claw back money that has been previously paid out. Every state has different laws on how far out insurance companies can do this. Not all CPT and HCPCS codes are time based codes.

G0270: This is actually not a CPT code, but rather a Healthcare Common Procedure Coding System (HCPCS) code. This code can be used to get additional follow up appointments beyond the general 3 hour and 2 hour limit that Medicare has. This benefit must be billed “incident to” a physician or other prescribing provider, so most dietitians in private practice are not rendering this service.
G0447: The G0447 code is used to bill Medicare for Intensive Behavioral Therapy for obesity.
G0473: HCPCS Code G0473 is very similar to the G0447 code, but it is used for a group, rather than an individual.
S9470: HCPCS code S9470 is defined as, “nutritional counseling, dietitian visit,” and is the original nutrition counseling code as it existed before the MNT codes were introduced. Now that the MNT codes have been around, you may or may not see S9470 being covered by private payers.
G0108: G0108 is a time-based code with a unit of 30 minutes.
G0109: HCPCS code G0109 is very similar to G0108, but it is used for groups. This code is used when training a patient on a continuous glucose monitor (CGM). A dietitian will need to bill incident to a physician when billing Medicare.
95249: This code is similar to CPT code 95249, but is used when a professional CGM, rather than a personal CGM, is provided. The same rules regarding billing incident to apply.
94690: CPT code 94690 is described as, “oxygen uptake, expired gas analysis; rest, indirect (separate procedure).” This is a pulmonary diagnostic testing and therapies code, but can potentially be billed when using indirect calorimetry, such as a MedGem, to measure resting metabolic rate.
98967: CPT code 98967 is used when the medical discussion is 11-20 minutes long.
99411: CPT code 99411 is used if this service is provided in a group setting and approximately 30 minutes long.

Important Considerations for Reimbursement

Contract Agreements

Once you have gone through the credentialing process with each insurance company and are accepted, they will send you a contract. In the contract it will state the allowable CPT codes you can bill with. The contract will also describe the specific allowable compensation per unit billed. Each of the CPT codes dietitians can use to bill is associated with a fixed rate. The rate does not change. Each time you bill a particular insurance company using 97802 you will receive the same compensation per 15-minute unit billed. Please keep in mind while your reimbursement rate is static for the course of your contract, whether or not the patient has coverage for these services is variable depending on their particular policy. Therefore, I would highly recommend having your patients verify their nutritional benefits PRIOR to their visit.

Preventative Care

In addition, certain insurance companies allow for the use of Preventative Care CPT codes. It will always depend on the plan and policy. Education by itself is never covered - but MNT pre/peri/post pregnancy would be.

Telehealth Billing

Each insurance company requires we bill using a different format for telehealth. Currently March 2022 there is no universal billing for telehealth. You need to check with each insurance company to confirm how they are requiring telehealth be indicated on the claim.

Denials and Appeals

Hello, we have had clients get denials when they switch insurance plans because the new plan does not have record of the initial session 97802 and thinks we are billing 97803 without it. These are a pain to fix through reconsideration. Do you know if it’s okay to bill 97802 as the first appointment on a new plan even if you’ve already been seeing the client? Honestly - we only use 97802 for an initial visit or if we have not seen the patient in > 1 year. We never use when they switch insurances - as technically it is NOT an initial visit.

Non-Face-to-Face Time

You CANNOT bill insurance for any time not with the patient not face:face providing MNT. Unfortunately that time is already factored into the CPT codes we bill with. That is why we are paid more for an initial visit than a follow up.

Incident-To Billing

This benefit must be billed “incident to” a physician or other prescribing provider, so most dietitians in private practice are not rendering this service. No - not unless you want the money to go to the MD.

Updates and Changes

The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association.

08/2022 - Transmittal 11545 dated August 5, 2022, is being rescinded and replaced by Transmittal 11584, dated, August 31, 2022.
08/2022 - The purpose of this Change Request (CR) is to provide a maintenance update of ICD-10 conversions and other coding updates to specific NCDs.
06/2022 - Transmittal 11400, dated May 4, 2022, is being rescinded and replaced by Transmittal 11460, dated, June 17, 2022, to update NCD 90.2, NGS, spreadsheet to conform with changes in CR 12124, and change the implementation date for all business requirements except 12705.6 to 30 days from issuance of this correction.
05/2022 - Transmittal 11272, dated February 18, 2022, is being rescinded and replaced by Transmittal 11426, dated, May 20, 2022 to revise chapter 32 of the IOM for Pub. 100-04. This correction does not make any revisions to the companion Pub. 100-02 or Pub. 100-03; all revisions are associated with Pub. 100-04. All other information remains the same.
05/2022 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
02/2022 - The purpose of this Omnibus change request is to make Medicare contractors aware of the updates to remove two National Determination NCDs, updates to the Medical Nutritional Therapy (MNT) policy and updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) resulting from changes specified in the calendar year 2022 Physician Fee Schedule (PFS) final rule published on November 19, 2021.
01/2021 - Transmittal 10515, dated December 10, 2020, is being rescinded and replaced by Transmittal 10566, dated, January 14, 2021 to remove FISS Reason Codes (RCs) 59041, 59042, 59209, and 59210 from the spreadsheet for NCD 160.18. All other information remains the same.
12/2020 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, longstanding NCD process.
10/2020 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, longstanding NCD process.
02/2017 - This change request (CR) is the 10th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). Previous NCD coding changes appear in ICD-10 quarterly updates as follows: CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, CR9631, and CR9751, as well as in CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
11/2016 - This change request (CR) is the 9th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, and CR9631. Some are the result of revisions required to other NCD-related CRs released separately. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
08/2016 - This change request (CR) is the 9th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, and CR9631. Some are the result of revisions required to other NCD-related CRs released separately. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
12/2015 - This change request (CR) is the 3rd maintenance update of ICD-10 conversions/updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, & CR9087. Some are the result of revisions required to other NCD-related CRs released separately that included ICD-10 coding. Implementation date: 01/04/2016 Effective date: 10/1/2015.
08/2015 - This change request (CR) is the 3rd maintenance update of ICD-10 conversions/updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, & CR9087. Some are the result of revisions required to other NCD-related CRs released separately that included ICD-10 coding. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 01/04/2016 Effective date: 10/1/2015.
05/2014 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/06/2014 Effective date: 10/1/2015.
03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/07/2013 Effective date: 10/1/2015.
05/01/2002 - Defined duration and frequency of the MNT benefit and how MNT and DSMT benefits are coordinated. To provides guidelines on reimbursement of Medical Nutrition Therapy (MNT).
07/24/2025: General formatting changes. Updated Limitations and Exclusions based on updated verbiage from Legal. Updated link for CMS National Coverage Determination (NCD) - Medical Nutrition Therapy (180.1).

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