Medicare MNT referral
DefinitionMedicare covers MNT only when a physician refers the patient with a diabetes or renal disease diagnosis; the referring NPI must be on the claim.
Medicare Part B covers MNT only on a physician's referral (42 CFR 410.132). The rules that trip practices up, from CMS's MNT billing instructions (Claims Processing Manual, Ch. 4, §300.2):
- Who can refer: a physician, which the regulation defines as a doctor of medicine or osteopathy. The referral must follow a diagnosis of diabetes or renal disease, documented by the referring physician in the patient's record.
- Every calendar year: the beneficiary needs a new referral for follow-up hours.
- Extra hours: hours beyond the basic allowance need a second referral for a change in diagnosis, condition or treatment, billed with G0270/G0271.
- On the claim: the referring physician's NPI must be on the CMS-1500 (items 17 and 17b). MACs return claims that lack it.
Keep the signed referral in the chart and track its calendar year the way you track hours used. For the diagnoses and hours themselves, see the Medicare coverage page.