Glossary

Nutrition billing glossary

The terms that come up between a nutrition visit and a paid claim, defined in plain English, each with the primary source it comes from.

• 8-minute rule (counting MNT units)The midpoint convention for time-based codes: a 15-minute unit is billable once you pass 7.5 minutes, so 8-22 minutes is 1 unit, 23-37 is 2.
• ADIME noteA dietitian note format that mirrors the Nutrition Care Process: Assessment, Diagnosis (PES), Intervention, Monitoring and Evaluation.
• BlueCard programThe Blue Cross Blue Shield program that lets you file an out-of-area Blue member's claim with your own local Blue plan, which routes it to theirs.
• CARC (claim adjustment reason code)Standard codes on an ERA or EOB that explain why a claim line was paid differently from what was billed, paired with a group code like CO or PR.
• ClearinghouseThe intermediary that checks claims, converts them into the standard electronic format (837P) and routes them to payers, then returns statuses and ERAs.
• CPT 97802 (initial MNT assessment)The CPT code for a patient's first MNT visit: initial nutrition assessment and intervention, one patient, face to face, per 15 minutes.
• CPT 97803 (MNT follow-up and reassessment)The CPT code for individual MNT visits after the first one: reassessment and intervention, face to face, billed in 15-minute units.
• CPT 97804 (group MNT)The CPT code for group medical nutrition therapy with two or more patients, reported in 30-minute units instead of 15-minute units.
• Eligibility check (270/271)An electronic question to a payer (the 270) and its answer (the 271): is coverage active, and what are the member's benefits and cost share.
• EOB (explanation of benefits)A readable statement from the payer explaining how a claim was processed: allowed amount, payment, adjustments and what the patient owes.
• ERA (electronic remittance advice)The electronic explanation of a claim payment (the X12 835 transaction): what was paid, adjusted or owed by the patient, line by line.
• Insurance credentialingGetting approved and contracted by a payer so you can bill in-network: verified qualifications, a signed contract and an effective date.
• Medicare MNT referralMedicare covers MNT only when a physician refers the patient with a diabetes or renal disease diagnosis; the referring NPI must be on the claim.
• MNT (medical nutrition therapy)Nutrition assessment, nutrition diagnosis and counseling by a registered dietitian to manage a medical condition, billed with CPT 97802-97804.
• Modifier 95 (synchronous telemedicine)A CPT modifier added to a service line to show it was delivered by real-time, two-way audio and video telemedicine instead of in person.
• NPI (National Provider Identifier)The unique 10-digit number HIPAA requires on every electronic claim. Dietitians get one free from CMS's NPPES; Type 1 is individual, Type 2 organization.
• PES statementThe nutrition diagnosis sentence in the Nutrition Care Process: Problem related to Etiology as evidenced by Signs and Symptoms.
• POS 10 and POS 02 (telehealth place of service)Place-of-service codes for telehealth: POS 10 when the patient is in their home, POS 02 when the patient is somewhere other than home.
• Preventive vs. medical benefitThe two ways a plan can pay for nutrition counseling: preventive (ACA, often no cost share) or medical (normal copay, coinsurance, deductible).
• Prior authorizationApproval a plan requires before a service for it to be covered. Most plans don't require it for routine MNT, but some do, often past a visit threshold.
• SOAP noteThe general clinical note format used across medicine: Subjective, Objective, Assessment and Plan. Many private-practice RDs chart MNT in it.
• SuperbillAn itemized, coded receipt a self-pay patient submits to their own insurer for out-of-network reimbursement; the practice does not file the claim.
• Timely filing limitThe deadline for a payer to receive a claim, counted from the date of service: 1 calendar year for Medicare, and set by contract for other payers.
• Z68 BMI codesICD-10-CM category for body mass index: adult ranges Z68.1-Z68.45 and pediatric percentiles Z68.51-Z68.56, reported only as secondary codes.
• Z71.3 (dietary counseling and surveillance)The ICD-10-CM code for dietary counseling and surveillance: it describes why the visit happened, not a disease, and payers treat it very differently.