Insurance coverage · Coverage
Humana Medicare Advantage nutrition therapy
By Javier Alvarez · Updated · 3 min read
| Baseline | Original Medicare MNT: NCD 180.1; diabetes, CKD, kidney transplant within 36 months |
|---|---|
| Hours | 3 hours the first year, 2 hours each later year; more with a new referral (G0270/G0271) |
| Member cost | Humana says MNT is covered at 100% with no deductible or copay |
| Prior authorization | 97802–97804, G0270, G0271 not on Humana's MA/D-SNP PA list (eff. 07/01/2026) |
| HMO referral | May be required; the referral number goes in Box 23 or loop 2300 REF02 |
| PPO referral | Humana: not required (Medicare's physician MNT referral still is) |
| Timely filing | Medicare lines: 1 year from date of service (Humana 2026 manual) |
| Last verified | September 28, 2026 |
The short answer
Medicare Advantage plans must cover at least what Original Medicare covers, and Humana's plans are no exception. For registered dietitians, that means medical nutrition therapy for diabetes, chronic kidney disease (not on dialysis) or a kidney transplant within the last 36 months, with a referral from the treating physician, under NCD 180.1.
Humana's own member page on nutrition therapy restates those rules: 3 hours in the first year, 2 hours each year after, a doctor's referral, and coverage at 100% with no deductible or copay.
We looked for a Humana-specific MNT policy in its claims payment policies and medical coverage policies and didn't find one. The Humana-specific rules that matter are about referrals and authorization, not about MNT itself.
What Humana adds on top of Medicare
No prior authorization for MNT. Humana's Medicare Advantage and D-SNP prior authorization list (effective July 1, 2026) doesn't include 97802, 97803, 97804, G0270 or G0271.
Referrals depend on the plan type. Humana's 2026 provider manual says:
- HMO: "For patients with HMO plans, referrals may be required." The PCP requests the referral and receives a referral number. On gated products, specialist claims include the referral authorization number in Box 23 of the CMS-1500 (or loop 2300 REF02 electronically). "If the referral authorization number is not on the claim, the claim may be denied," and the member can't be balance billed for that denial.
- PPO: "Referrals are not required for members with PPO plans."
Don't confuse the two referrals. A PPO member doesn't need a Humana plan referral, but Medicare's MNT rule still requires a referral from the treating physician for the diagnosis. Keep that in the chart for every Humana MA member. Our MNT referral form template covers what it should include.
Timely filing. The manual lists one year from the date of service for Medicare lines of business, unless your contract says otherwise.
Who can bill
To bill MNT to a Humana Medicare Advantage plan you need to be:
- Enrolled in Medicare as a registered dietitian or nutrition professional. See Medicare enrollment for dietitians.
- In Humana's network for HMO members. PPO members can see out-of-network providers, usually at a higher cost share, so check the plan.
- Billing your own NPI on claims sent to Humana, not to the Medicare Administrative Contractor.
For how MA plans differ from Original Medicare in general, read Medicare Advantage billing for dietitians.
Codes, hours and diagnoses
| Item | Rule (Original Medicare baseline) |
|---|---|
| Diagnoses | Diabetes; chronic kidney disease not on dialysis; kidney transplant within 36 months |
| Initial | 97802, 15-minute units |
| Follow-up | 97803, 15-minute units |
| Group | 97804, 30-minute units |
| Hours | 3 in the first calendar year, 2 per year after |
| More hours | New physician referral for a change in diagnosis, condition or treatment; G0270 (individual) or G0271 (group) |
| Cost to member | $0 (Humana states 100% coverage) |
Obesity, prediabetes, hyperlipidemia or IBS alone don't qualify under MNT. If a plan offers extra nutrition benefits, they'll be in the member's Evidence of Coverage, not in Medicare's rule. Codes in detail: G0270 and G0271, and the full Medicare picture in our Medicare MNT billing guide.
Telehealth
Medicare MNT has been on the Medicare telehealth list, and MA plans can offer telehealth beyond Original Medicare. Humana publishes a separate telehealth claims payment policy for MA; check it and the member's plan for current place-of-service and modifier rules. Background: Medicare telehealth for nutrition therapy.
How to verify a Humana Medicare Advantage member's benefits
- Plan type: HMO, PPO, D-SNP or another MA product. It decides the referral rule. See 270/271 eligibility checks.
- Network status for that plan.
- Diagnosis: diabetes, CKD (not on dialysis) or transplant within 36 months, documented by the referring physician.
- Hours used this calendar year, across providers.
- HMO referral number, if required, before the visit.
- Supplemental benefits: any extra nutrition visits in the member's Evidence of Coverage.
- Record the rep's name, date and reference number (verification call script).
Not legal or billing advice. Humana plans differ and policies change; check the member's plan and Humana's current lists before billing.