Guides · Billing guide
How do you bill 97802 and 97803 without denials?
By Javier Alvarez · Updated · 5 min read
| 97802 | First MNT visit with the patient, individual, each 15 minutes |
|---|---|
| 97803 | Every individual follow-up, each 15 minutes |
| Units | A 15-minute unit counts once you pass the midpoint (8 minutes); some payers want the full 15 |
| Diagnosis order | As the payer asks; a Z68 BMI code never goes first |
| Medicare | MD or DO referral, NPI in box 17b, diabetes or kidney diagnosis only |
| Telehealth POS | 10 when the patient is at home, 02 anywhere else; modifier as the payer asks |
This guide is for registered dietitians billing US insurance for medical nutrition therapy. Payer rules differ by plan and change every year, so check your payer's current policy too. Which code fits which visit is covered in depth in CPT 97802 vs 97803; this page is the checklist you run before you press submit.
The eight checks, and the denial each one prevents
| Check before you submit | What goes wrong without it | Usual adjustment code |
|---|---|---|
| 1. 97802 only for the first visit; 97803 after | A follow-up billed as a first visit, or both codes on one date | CO-97, CO-16 |
| 2. Units match the minutes in the note | More units than the documented time supports | CO-151, CO-16 |
| 3. A diagnosis the plan covers for MNT | Obesity or a preventive code on a plan that covers only certain conditions | CO-167, CO-11, CO-96, CO-272 |
| 4. Diagnoses in the order the payer asks; never a Z68 BMI code first | A BMI code in the first position, or Z71.3 first on a plan that pays on the condition | CO-16, CO-11 |
| 5. Medicare: an MD or DO referral, NPI in box 17b | No referring provider, or a nurse practitioner as the referrer | CO-16 |
| 6. Telehealth: the right place of service and modifier | POS 11 on a video visit, or a missing modifier the payer requires | CO-5 or CO-58 for the place of service, CO-4 for the modifier |
| 7. Benefits checked: visits left, referral or authorization needed | The yearly visit limit already used, or no prior authorization | CO-119, CO-197 |
| 8. You are credentialed, and the claim goes out in time | The rendering NPI not on the contract, or the filing window missed | CO-170, CO-29 |
Adjustment code meanings come from the X12 code list. The same code can mean different things in practice depending on the remark code next to it, so read both. Our free denial checker reads a whole remittance line at once.
1. Use 97802 once, then 97803
97802 is the initial assessment and intervention; 97803 is the re-assessment for every individual follow-up. Both are reported per 15 minutes (CMS, Ch. 4 §300). Bill a long first visit as 97802 for its whole length, so 75 minutes is 97802 × 5 and not 97802 plus 97803. A patient you saw last year is still established for most plans, so the first visit of a new year is usually 97803. The exceptions are in the decision table.
2. Count units from the minutes you documented
Write the start and end time, or the total minutes, in every note. Counting a unit once you pass the midpoint, the convention CMS spells out for 15-minute codes, 8 to 22 minutes is 1 unit, 23 to 37 is 2, 38 to 52 is 3 and 53 to 67 is 4 (CMS, Ch. 5 §20.2). Some commercial plans want a full 15 minutes per unit, and some cap the units per visit, so check the contract. The MNT units calculator does the arithmetic, and the 8-minute rule guide explains it.
3 and 4. Pick a covered diagnosis, in the right order
Coverage for MNT depends on the diagnosis. Medicare covers it only for diabetes, kidney disease not on dialysis, and up to 36 months after a kidney transplant (NCD 180.1). Commercial plans vary: some cover Z71.3 as preventive counseling, some need a chronic condition. Order the codes the way the payer asks: Cigna's preventive policy wants a wellness code such as Z71.3 first, while UnitedHealthcare and Aetna pay nutrition counseling on the condition. A Z68 BMI code is a secondary code under the ICD-10-CM guidelines and never goes first; pair it with the obesity diagnosis it supports. Details in Z71.3 and the Z68 codes, and payer by payer in our insurance pages.
5. On Medicare, the referral goes on the claim
Medicare pays MNT only on a referral from the treating physician, an MD or DO (42 CFR 410.132). Put the physician's name and NPI in box 17 and 17b. A referral from a nurse practitioner or physician assistant doesn't qualify. Hours run 3 in the first calendar year and 2 after; more need a new referral and G0270. The full rules are in Medicare MNT coverage.
6. Telehealth: place of service and modifier
Use POS 10 when the patient is at home and POS 02 when they are somewhere else (CMS POS code set). Modifiers differ by payer: many commercial plans ask for modifier 95, and some want none. Check each payer's telehealth policy once and save the answer. More in telehealth billing for dietitians.
7 and 8. Benefits, credentials and time
Before the first visit, confirm the plan covers MNT for this diagnosis, how many visits are left this year, and whether it needs a referral or prior authorization. An electronic eligibility check rarely answers those for nutrition, so a call is often needed (what to ask). Bill under the NPI that is on the payer contract, and file inside the payer's window (timely filing calculator).
Which software runs these checks for you?
A clearinghouse catches missing or malformed data and returns a rejection; it doesn't judge the code, units or diagnosis. Most dietitian EHRs send what you enter. Here is who runs the eight checks, as of October 26, 2026:
| Picks 97802 or 97803 | Counts units from the visit | Payer diagnosis and referral rules | Sends the claim | |
|---|---|---|---|---|
| Claim.MD alone | You | You | Format edits only | Yes |
| Practice Better, Healthie, Kalix, SimplePractice | You | You | You | Yes, through their clearinghouse |
| Duo Practice | Drafted from the visit; you approve | Yes, from how long the session ran | Warns before you submit, with the rule's source | Yes, through your own Claim.MD account |
Duo Practice builds the claim from the signed note, then checks it against a rulebook of payer rules, each linked to its source: Medicare's referral and diagnosis rules, Aetna's September 2026 preventive changes, UnitedHealthcare's BMI code rule and BCBS of Illinois telehealth modifiers, among others. Today every rule in that rulebook warns rather than blocks: a rule would only block after we check it against claims already filed and find it would have stopped none that was paid. It doesn't verify benefits by phone, get prior authorizations or file appeals. Pricing is 3.9% of what the insurer pays, with nothing on a denied claim; see the billing service page. For the other tools and their prices, see best insurance billing software for dietitians.
When a denial comes back anyway
Read the adjustment and remark codes, fix the cause, and decide whether it is a rejection (fix and resend) or a denial (corrected claim or appeal). Rejection vs denial explains the difference, and how to appeal a denied nutrition claim covers the letter. The nine most common causes, with fixes, are in why nutrition claims get denied.
Duo Practice builds the claim from the visit, counts the units from the session and warns you about payer rules before it goes out. Try Duo Practice free
