CMS Pub. 100-04, ch. 4, § 300.2

Medicare covers 3 hours of MNT in the beneficiary’s initial calendar year. No initial hours

can be carried over to the next calendar year. For example, if a physician gives a referral to a

beneficiary for 3 hours of MNT but a beneficiary only uses 2 hours in November, the

calendar year ends in December and if the third hour is not used, it cannot be carried over

into the following year. The following year a beneficiary is eligible for 2 follow-up hours

(with a physician referral). Every calendar year a beneficiary must have a new referral for

follow-up hours.

Referral may only be made by a physician when the beneficiary has been diagnosed with

diabetes or renal disease.

Documentation must be noted by the referring physician in the beneficiary’s medical record.

Referrals must be made for each episode of care and reassessments prescribed during an

episode of care as a result of a change in medical condition or diagnosis. The National

Provider Identifier (NPI) number of the referring physician must be on the Form CMS-1500

claim submitted by a registered dietitian or nutrition professional. The A/B MAC (B) or A/B

MAC (A) shall return claims that do not contain the referring NPI of the referring physician.

NOTE: Additional covered hours of MNT services may be covered beyond the number of

hours typically covered under an episode of care when the physician determines there is a

change of diagnosis or medical condition within such episode of care that makes a change in

diet necessary. Appropriate medical review for this provision should only be done on a post

payment basis. Outliers may be judged against nationally accepted dietary or nutritional

protocols in accordance with 42 CFR 410.132 (a).