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Medicare MNT coverage: what dietitians can bill

By Javier Alvarez · Updated October 13, 2026 · 4 min read

These are the federal rules for Original Medicare Part B. Your Medicare Administrative Contractor (MAC) may publish its own billing guidance on top of them, so check it too. To enroll first, see Medicare enrollment for dietitians.

The benefit at a glance

The qualifying diagnoses

The diagnosis that qualifies the patient should be first on the claim. Common examples:

• Diabetes: E10.x (type 1), E11.x (type 2), E13.x (other specified). Since January 1, 2024, Medicare's definition of diabetes for this benefit is simply diabetes mellitus (the old lab-value criteria were removed from 42 CFR 410.130), and it includes gestational diabetes (O24.4x); that episode of care ends when the pregnancy ends.
• Kidney disease, not on dialysis: Medicare's regulation covers chronic renal insufficiency, defined as a glomerular filtration rate (GFR) of 15 to 59 ml/min/1.73m² (about stages 3a to 4, N18.31-N18.4), and end-stage renal disease when the patient is not on dialysis. Stages 1 and 2 don't qualify. Make sure the referral documents it.
• Kidney transplant: Z94.0 (kidney transplant status), within 36 months of the transplant.

If the referral lists only obesity (E66.x), hyperlipidemia (E78.x), hypertension (I10) or prediabetes (R73.03), MNT is not a Medicare benefit for that patient. Ordering codes is covered in Z71.3 and Z68 codes.

Hours and codes

Medicare counts hours per calendar year, not per 12 months from the first visit. In the first year, 3 hours equals 12 units of 15 minutes across 97802 and 97803 (group time with 97804 counts too). In later years, 2 hours equals 8 units of 97803.

MNT and diabetes self-management training (DSMT) are separate benefits. A patient can use both in the same year, but Medicare doesn't pay MNT and DSMT on the same day. Track hours per patient so you don't bill past the limit without a new referral. The MNT units calculator turns minutes into units.

Medicare Advantage

Medicare Advantage (Part C) plans must cover at least what Original Medicare covers, and most apply the same MNT rule: covered for diabetes and kidney disease, denied for other diagnoses. Some plans offer extra nutrition benefits, so check the plan. MA plans credential you separately (usually through CAQH). Because MNT is a Medicare-covered preventive service, an MA plan can't charge a deductible, copay or coinsurance for it when you are in network; out-of-network cost sharing follows the plan. See Medicare Advantage billing for dietitians.

When a plan denies MNT for a non-qualifying diagnosis, you'll typically see CARC 96 (non-covered charge), 50 (not reasonable and necessary) or 272 (coverage/program guidelines were not met), sometimes with RARC N386 (decision based on a National Coverage Determination).

Non-covered visits and the ABN

A Medicare patient may still want to see you for a condition Medicare doesn't cover for MNT, or for more hours than their referral allows. How you handle it depends on why it isn't covered:

• Diagnosis outside the MNT benefit (for example obesity alone): CMS tells contractors to deny MNT claims without a diabetes or kidney diagnosis as not reasonable and necessary, not as a statutory exclusion. So treat it like any expected denial: give the patient an ABN (form CMS-R-131) before the visit, get it signed, and bill with modifier GA. Without a signed ABN, bill with GZ, and you can't bill the patient.
• Covered diagnosis, but beyond the hour limit: the same rule, an ABN before the visit and modifier GA. If the physician refers again for a change in condition, the extra hours are covered and billed with G0270 or G0271 instead.

If you are enrolled in Medicare, you can't simply take cash for a covered MNT visit for a qualifying patient instead of billing Medicare. RDs can opt out of Medicare and use private contracts, but the rules are strict and apply to all your Medicare patients; check them before setting cash policies.

Worked example claim

A first-year Original Medicare patient with type 2 diabetes, initial visit of 60 minutes, referral from the treating physician on file.

CMS-1500 / 837P, Original Medicare

All data in this example is invented for illustration.