Insurance Billing

97802 vs 97803: Which Code, and Can You Bill 97802 Again?

When a visit is 97802 and when it's 97803, whether you can bill 97802 again after a gap or a new diagnosis, and what Medicare and commercial payers say.

By Javier Alvarez · Published September 29, 2026 · 5 min read

"She came back after a year. Is that 97802 again?" It's one of the most common coding questions in MNT billing, and the honest answer depends on who's paying. Medicare has a written rule. Commercial plans each have their own.

The short answer

• First MNT visit with a patient: 97802. Every later individual visit: 97803.
• Medicare: 97802 once, for the initial assessment of a new patient. New calendar years, new referrals and returning patients are still 97803. Extra hours after a change in condition are G0270.
• Commercial plans: some let you bill 97802 again after a gap, in a new plan year, or for a new diagnosis. It's the plan's rule, not a CPT rule, so get it from the plan.

Both codes are individual, face-to-face and billed in 15-minute units, so the units math is the same. Only the code changes.

What "initial" means to Medicare

CMS's claims manual says 97802 "must only be used for the initial visit" and should be used "only once for the initial assessment of a new patient." Every later individual visit, including reassessments, is billed as 97803 (Claims Processing Manual, ch. 4, §300.4).

The regulation frames MNT around an episode of care: the first 12 months when coordinated with initial diabetes training, and then one calendar year at a time, starting with the assessment (42 CFR 410.130). The hours reset each calendar year (3 hours the first year, 2 after). The code doesn't reset, so the first visit of a new year is 97803 with a fresh referral. Noridian states the referral part directly: every calendar year, the beneficiary needs a new referral.

What "initial" means to commercial payers

CPT itself doesn't define how long a patient stays "established" for MNT. That leaves each payer to decide, and you'll see several patterns:

• Once per patient per provider, matching Medicare.
• Once per plan year or calendar year, then 97803.
• Once per episode of care, where a new episode follows a gap or a new condition.
• A payer-specific limit written into the policy. Texas's CSHCN program, for example, lets one hour of 97802 per rolling year go without prior authorization, and denies 97803 billed on the same date as 97802 (TMHP manual, Oct 2020).

Because the answer varies by plan, the reliable move is to ask during verification and record it.

Can you bill 97802 again?

Work through the situation you actually have:

A new calendar year

• Medicare: no. It's 97803 with a new referral for the year's 2 follow-up hours.
• Commercial: only if the plan allows one 97802 per year. Ask.

A patient returning after a long gap

• Medicare: no. 97802 is for a new patient, and a returning patient isn't one. Bill 97803 under the current year's referral.
• Commercial: some plans treat a long gap as a new episode. If the plan confirms it, bill 97802 and document why a full reassessment was needed.

A new or changed diagnosis

• Medicare: a change in diagnosis, medical condition or treatment regimen calls for a second referral. The additional time is billed as G0270 or G0271, not 97802. A patient with diabetes who develops kidney disease is the classic case.
• Commercial: a new, unrelated diagnosis (say, an eating disorder in a patient you saw years ago for hyperlipidemia) may justify a new initial assessment on some plans. Confirm first.

A patient switching dietitians

If the patient is new to you, your first visit is generally 97802. For Medicare, remember the hours belong to the patient. If another dietitian already billed 2 of this year's 3 hours, you have 1 hour left before a second referral is needed. There's no universal lookup for remaining MNT hours, so ask the patient and the referring office, and check your MAC's tools.

Moving to a new practice yourself

The patient hasn't changed, but the billing entity has. Medicare's rule is tied to the patient being new, so treat carefully: most patients you bring with you are established in your care, and billing 97802 again invites a denial. For commercial plans, ask.

What the claim looks like in each case (invented examples)

How to confirm with the payer

Ask by code, not by service. "Nutrition counseling is covered" doesn't answer your question. On the verification call:

1. "Is CPT 97802 limited to once per patient, per year, or per episode?"
2. "If this member had 97802 with another provider, can I bill 97802?"
3. "Do 97802 and 97803 share a visit or unit limit? How many remain this year?"
4. "Is a referral or authorization required, and does it expire?"
5. Write down the rep's name, the date and the call reference number.

The full script is in insurance verification for dietitians. For Medicare specifics, see the Medicare MNT billing guide.

If you already billed the wrong one

A 97802 denied because the patient is established isn't an appeal. It's a coding correction. Change the line to 97803, keep the same units, and send it as a corrected claim (frequency code 7 on an electronic claim). If a payer paid a second 97802 and later asks for the money back, read the remit carefully and fix the pattern in your templates so it doesn't repeat. The broader playbook is in nutrition claim denials.

Part of MNT CPT & HCPCS codes.