Medicare coverage for the initial Medical Referral
Medicare allows for 3 hours (12 units) of MNT for clients with diabetes during the initial year of the diabetes diagnosis and 2 hours (8 units) for each calendar year after the year of diagnosis. The initial visit is coded 97802 and the follow-up visits are coded with 97803.
Additional time will be covered with a second referral
Under certain circumstances, Medicare will allow additional hours. A second referral needs to be written by the physician indicating one of the following issues:
- Choice of check off justifications the Doctor can use:
a) change in medication from oral to insulin; oral to GLP 1 GA–new MD treatment plan
b) EGFR abnl…with diabetes diagnosis; now you’ll work on CKD
c) lack of understanding
d) EGFR stage changes for CKD
e) episodes of hypo or hyperglycemia
f) A1c not at goal
g) new to MD
h) change in insulin: carb ratios new MD treatment plan etc.
- When new referral is received, 1:1 MNT units are billed G0270,or
group G0271 can be used.
Next calendar year (beginning Jan 1st) it reverts back to 97803 for followup with the 2hrs new Rx etc…and additional
request above the 2hr (8 units) requires the same scenario as above.