Medical Nutrition Therapy Benefit for Diabetes & ESRD

CMS NCA document | source_status=Closed | review_type=New | public_comment_open=False | document_id=CAG-00097N

The following chart outlines the duration and frequency coverage for MNT for both renal disease and diabetes. The only restriction imposed in this decision is regarding the number of hours of basic coverage per year. The referring physician will be free to determine the exact length and number of the visits as long as the yearly limit is not exceeded. Type of MNT (Any Covered Diagnosis) Number of Hours Covered per Year 28 Initial MNT 3 Follow-up MNT 2 Pursuant to the exception at 42 CFR 410.32(b)(5), additional hours are considered to be medically necessary and covered if the treating physician determines there is a change in medical condition, diagnosis, or treatment regimen that requires a change in MNT and orders additional hours during that episode of care. In addition, if the treating physician determines that receipt of both services is medically necessary, Medicare will cover both DSMT and MNT in initial and subsequent years without decreasing either benefit as long as DSMT and MNT are not provided on the same dates of service. (The information contained here represents only the first step towards making coverage of these services effective. A manual instruction must be prepared and approved, and the necessary billing and claims processing instructions must be prepared. In addition, changes must be made to bill processing systems in order to allow payment to be made. Consequently, the effective date of service will not be known until the manual instruction has completed the clearance process and been assigned an effective date.)