CMS Pub. 100-04, ch. 4, § 300

Section 105 of the Medicare, Medicaid, and SCHIP Benefits Improvement and

Protection Act of 2000 (BIPA) permits Medicare coverage of Medical

Nutrition Therapy (MNT) services when furnished by a registered dietitian or

nutrition professional meeting certain requirements. The benefit is available

for beneficiaries with diabetes or renal disease, when referral is made by a

physician as defined in §1861(r)(l) of the Social Security Act (the Act). It also

allows registered dietitians and nutrition professionals to receive direct

Medicare reimbursement for the first time. The effective date of this provision

is January 1, 2002.

The benefit consists of an initial visit for an assessment; follow-up visits for

interventions; and reassessments as necessary during the 12-month period

beginning with the initial assessment (“episode of care”) to assure compliance

with the dietary plan.

Effective October 1, 2002, basic coverage of MNT for the first year a

beneficiary receives MNT with either a diagnosis of renal disease or diabetes

as defined at 42 CFR, 410.130 is 3 hours. Also effective October 1, 2002,

basic coverage in subsequent years for renal disease is 2 hours.

For the purposes of this benefit, renal disease means chronic renal

insufficiency or the medical condition of a beneficiary who has been

discharged from the hospital after a successful renal transplant within the last

36 months. Chronic renal insufficiency means a reduction in renal function

not severe enough to require dialysis or transplantation (glomerular filtration

rate (GFR) 15–59 ml/min/1.73m²). Effective January 1, 2004, the Centers for

Medicare & Medicaid Services (CMS) updated the definition of diabetes to

be as follows: Diabetes is defined as diabetes mellitus, a condition of

abnormal glucose metabolism diagnosed using the following criteria: a

fasting blood sugar ≥ 126 mg/dL on two different occasions; a 2-hour post-glucose challenge ≥ 200 mg/dL on 2 different occasions; or a random glucose

test over 200 mg/dL for a person with symptoms of uncontrolled diabetes.

Effective for claims with dates of service on or after January 1, 2024,

“diabetes” means diabetes mellitus, a condition of abnormal glucose

metabolism. The specific test-based clinical criteria described above is no

longer included in the regulatory definition of “diabetes” for purposes of

MNT at 42 CFR 410.130.

The MNT benefit is a completely separate benefit from the diabetes self-management training (DSMT) benefit. CMS had originally planned to limit

how much of both benefits a beneficiary might receive in the same time

period. However, the national coverage determination, published May 1,

2002, allows a beneficiary to receive the full amount of both benefits in the

same period. Therefore, a beneficiary can receive the full 10 hours of initial

DSMT and the full 3 hours of MNT. However, providers are not allowed to

bill for both DSMT and MNT on the same date of service for the same

beneficiary.