Billing codes · CPT code
CPT 97803: the MNT follow-up code
By Javier Alvarez · Updated · 4 min read
| Code | 97803 (CPT, Category I) |
|---|---|
| What it covers | MNT re-assessment and intervention, one patient, face-to-face |
| Unit length | 15 minutes (1 unit from 8 minutes) |
| When to use | Every individual MNT visit after the initial 97802 |
| Medicare status (2026 PFS) | A (active, separately paid); on the Medicare telehealth list |
| Medicare MUE | 11 units per day (practitioner table effective Oct 1, 2026) |
| Medicare hours | Shares the 3-hour first-year / 2-hour later-year MNT allowance |
| Beyond the hours (Medicare) | New referral for a change in condition, billed as G0270 |
If 97802 opens the chart, 97803 carries it. In a typical caseload most MNT claims are 97803, which means most unit mistakes and most "benefit maximum reached" denials happen on this code.
What 97803 means in plain English
CPT describes 97803 as medical nutrition therapy, re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes. In practice:
- Re-assessment and intervention. You check progress against the plan from the initial visit, adjust it, and continue counseling.
- Individual and face-to-face. One patient, live, in person or by video. A group follow-up is 97804.
- Each 15 minutes. Bill units from documented face-to-face minutes.
Medicare's manual tells dietitians to bill all reassessments and interventions after the initial visit as 97803, including visits prompted by a change in the patient's condition that affects nutrition status (Claims Processing Manual, ch. 4, §300.4).
When a visit is 97803 and not 97802
The switch is simple for Medicare and less simple for commercial plans:
- Medicare: 97802 once, for the first assessment of a new patient. Every later individual visit is 97803, including the first visit of a new calendar year. When the patient has used up the year's hours and the physician sends a second referral for a change in diagnosis, condition or treatment, the extra time is G0270, not 97803.
- Commercial: most plans follow the same pattern, but some let you bill a new 97802 after a gap in care or at the start of a new plan year. That rule belongs to the plan. We cover the edge cases in 97802 vs 97803.
Units: minutes to 97803 units
| Face-to-face minutes | 97803 units | Typical visit |
|---|---|---|
| 8–22 | 1 | Short check-in |
| 23–37 | 2 | 30-minute follow-up |
| 38–52 | 3 | 45-minute follow-up |
| 53–67 | 4 | 60-minute follow-up |
| 68–82 | 5 | Long reassessment |
The table follows the CPT midpoint rule for 15-minute codes. Our 8-minute rule guide covers what time counts. The short version: face-to-face minutes only, never charting.
Medicare's practitioner MUE for 97803 is 11 units per day (table effective October 1, 2026, adjudication indicator 2). You'll almost never reach that in one follow-up, but check the current MUE table because values change every quarter.
Visit and hour limits
Medicare
Medicare limits hours, not visits. Under NCD 180.1 and the claims manual:
| Year | MNT hours | In 15-minute units | Referral |
|---|---|---|---|
| First calendar year of MNT | 3 hours | 12 units (97802 + 97803 combined) | Physician referral |
| Each later calendar year | 2 hours | 8 units | New physician referral each year |
| Change in condition during the year | Additional hours | Billed as G0270 | Second referral |
Unused hours don't carry into the next year. Here's the math that matters: a 4-unit 97802 in March leaves 8 units of 97803 for the rest of that calendar year. Plan the visit cadence around that, and tell the patient up front.
If a visit goes past the covered hours without a new referral, the patient may be liable. CMS says an Advance Beneficiary Notice should be issued in that situation, and without a valid ABN the provider is liable (§300.6).
Commercial plans
Commercial limits are set by the member's plan: some count visits, some count units, some have none. An employer's self-funded plan can differ from the same carrier's fully insured plan. Ask by code on the benefits call: "How many 97803 visits or units are covered per year, and does 97802 count toward that limit?" The verification call script has the full list.
ICD-10 pairing for follow-ups
Use the diagnosis that supports this visit, not just the one from the first referral:
- If the condition changed (for example, a patient with diabetes who now has CKD), update the diagnosis. For Medicare, that change is also what justifies a second referral and G0270 hours.
- For weight-related visits, keep the obesity code and a current Z68 BMI code aligned with the measurement in the note.
- Z71.3 alone rarely carries a medical-benefit follow-up. Check how the plan routes it.
Telehealth billing for 97803
97803 is on the CY 2026 Medicare telehealth list. Through December 31, 2027, Medicare beneficiaries can be seen at home. On professional claims, report POS 10 (patient at home) or POS 02 (elsewhere). CMS's current MLN booklet doesn't list modifier 95 for professional claims, but Medicare Advantage and commercial plans often require it. Check each plan's telehealth policy. More detail: telehealth billing for dietitians.
Common 97803 denials and the fix
| Problem | Why it happens | Fix |
|---|---|---|
| Benefit maximum reached (CO-119) | Year's Medicare hours or the plan's visit limit used up | Medicare: new referral for a change in condition, then G0270. Commercial: check for a medical-necessity extension or offer self-pay with notice |
| Referral missing for the new year (Medicare) | Last year's referral doesn't cover this year | Get the new referral before the first visit of the year |
| 97803 billed the same day as 97802 | Both codes on one date | Bill the whole first visit as 97802 |
| Units don't match the note | Minutes missing or rounded by habit | Record start and stop times or total minutes in every note |
| Wrong diagnosis routing (CO-167) | Preventive vs medical benefit mismatch | Resequence to the plan's required diagnosis and resubmit |
Example claim line (invented)
A commercial patient with prediabetes comes back for her third visit. The video session runs 34 minutes, with the patient at home.
- CPT: 97803 × 2 units (34 minutes falls in 23–37)
- Diagnosis: R73.03, pointer A
- POS: 10, plus modifier 95 if this plan's telehealth policy asks for it
- Before submitting: confirm the plan's visit limit, since this is visit 3