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Medical Nutrition Therapy (MNT)/Nutrition Counseling
10.00.04

Policy

For covered Preventive Services addressing behavioral interventions for weight loss or behavioral health conditions, refer to medical policy 00.06.02 Preventive Care Services. 


MEDICALLY NECESSARY


MEDICAL NUTRITION THERAPY/NUTRITION COUNSELING
Medical Nutrition Therapy (MNT)/Nutrition Counseling ​is considered medically necessary and, therefore, covered when furnished by a Registered Dietiti​an or other qualified professional provider, and both of the following are met: 

  • MNT/Nutrition Counseling is prescribed by a professional provider.

  • MNT/Nutrition Counseling​ is being administered to improve nutritional status, to prevent complications of chronic conditions, and/or to lower risk factors that can be affected by diet. ​The following list of diagnoses/conditions are those for which MNT/Nutrition Counseling​ commonly improves health outcomes. (Note: This is not an all-inclusive list):

    • Behavioral health conditions or substance use disorders that impact weight or nutritional status when MNT is being provided as part of a multidisciplinary therapy program (e.g., alcohol use and eating disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder) 
    • Cancer 
    • Cardiovascular disease
    • Chronic nonhealing wounds
    • Chronic obstructive pulmonary disease 
    • Cystic fibrosis 
    • Drug-resistant epilepsy (e.g., ketogenic diet)
    • Genetic (inherited) inborn errors of metabolism (IEM) 
      • Branch-chain ketonuria
      • Galactosemia
      • Homocystinuria
      • Maple syrup urine disease
      • Phenylketonuria (PKU)
    • Hypertension​
    • Human immunodeficiency virus (HIV) disease/acquired immunodeficiency syndrome (AIDS) 
    • Malabsorption or storage disorders
      • Amyloidosis (primary and secondary)
      • Celiac disease
      • Chronic intestinal pseudo-obstruction (Ogilvie syndrome)
      • Gastroesophageal reflux disease (GERD)
      • Glycogen storage disorders (e.g., Anderson disease, Forbes disease, Hers disease, McArdle disease, Pompe disease, Tarui disease, Von Gierke disease)
      • Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis)
      • Short bowel syndrome
      • Lipid storage disorders (e.g., Fabry disease, Gaucher disease, Neimann-Pick disease)
    • Malnutrition (includes undernutrition, vitamin or mineral deficiencies, overweight [BMI 25–29.9 kg/m2 for adults or from the 85th to less than the 95th percentile for children], obesity [BMI ≥30 kg/m2 for adults or above the 95th percentile for children])
    • Metabolic disorders
      • Diabetes (e.g., newly diagnosed diabetes, uncontrolled diabetes, gestational diabetes) or prediabetes
      • Hyperlipidemia
      • Hypothyroidism
      • Metabolic syndrome (insulin resistance)
    • Multiple or severe food allergies that if left untreated would cause malnourishment, chronic physical disability, mental retardation, or death
    • Pregnant individuals with any of the following high-risk criteria:
      • Gestational diabetes
      • Age younger than 18 years
      • Multiple gestation
      • Prepregnancy BMI of >30 or <19.1 kg/m2
      • Pre-existing condition requiring nutritional intervention (e.g., diabetes, cardiac disease)
      • Poor weight gain
      • Hyperemesis gravidarum
      • Osteoporosis
    • Renal (kidney) disease (but not on dialysis) or post kidney transplant
    • Spina bifida/spinal cord injuries
    • Swallowing impairment/dysfunction (e.g., related to head and neck cancer and/or head and neck surgery)
    • Weight management (e.g., weight loss prior to bariatric surgery) 

​REQUIRED DOCUMENTATION 


The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the professional provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.​

Guidelines

​NUTRITIONALLY-AT-RISK ADULTS

Adults should be considered at risk if they have any of the following:

  • Involuntary loss of 10% or more of usual body weight within 6 months, or involuntary loss of greater than or 5% or more of usual body weight in 1 month
  • Involuntary loss or gain of 10 pounds within 6 months
  • Body mass index less than 18.5 kg/m2 or greater than 25 kg/m2
  • Chronic disease
  • Increased metabolic requirements
  • Altered diets or diet schedules
  • Inadequate nutrition intake, including not receiving food or nutrition products for greater than 7 days

NUTRITIONALLY-AT-RISK CHILDREN


Children should be considered at risk if they have any of the following:

  • A weight for length or weight for height or sex less than the 10th percentile or greater than the 95th percentile
  • Body mass index for age or sex less than 5th percentile or greater than the 85th percentile
  • Increased metabolic requirements
  • Impaired ability to ingest or tolerate oral feedings
  • Documented inadequate provision of or tolerance of nutrients
  • Inadequate weight gain or a significant decrease in usual growth percentile

​​ASPEN definition of terms (2015) for Malnutrition ASPEN | Definitions (nutritioncare.org)​


BENEFIT APPLICATION


Subject to the terms and conditions of the applicable benefit contract, Medical Nutrition Therapy (MNT)/Nutrition Counseling is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

The provision of benefits for all services related to Medical Nutrition Therapy (MNT)/Nutrition Counseling is in accordance with the individual's benefit contract and varies by product and group. Therefore, individual member benefits must be verified. ​​

Description

According to the Commission on Dietetic Registration, Medical Nutrition Therapy (MNT) is an evidence-based application of the nutrition care process. The provision of MNT to an individual may include one or more of the following: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation that typically results in the prevention, delay, or management of diseases and/or conditions. 

The nutrition intervention component of MNT is defined as purposefully planned actions designed with the intent of changing a nutrition-related behavior, risk factor, environmental condition, or aspect of health status and is a critical component of the nutrition care process. The nutrition intervention includes five domains: food and nutrient delivery, nutrition education, nutrition counseling, coordination of nutrition care, and population-based nutrition action. 

Nutrition counseling is a supportive process, characterized by a collaborative counselor-client relationship to establish food and nutrition priorities, goals, and individualized action plans and general physical activity guidance that acknowledge and foster responsibility for self-care to treat an existing condition or to promote health. Nutrition counseling and education can be administered separately or as part of the nutrition care process, which is the application of MNT. If the professional provider has not completed the steps of the nutrition care process and is providing generalized nutrition information, not individualized to the client’s needs, this would constitute general nutrition counseling/education.

References

​Academy of Nutrition and Dietetics Evidence Analysis Library AWM Workgroup (2022) Evidence-Based Nutrition Practice Guideline, Chicago, IL. Available at: https://www.andeal.org/topic.cfm?menu=5276​  https://www.andeal.org/topic.cfm?menu=5276​.  

American Psychological Association, Clinical Practice Guideline Panel. (2018). Clinical practice guideline for multicomponent behavioral treatment of obesity and overweight in children and adolescents: Current state of the evidence and research needs​​.Available at: Clinical Practice Guideline for Multicomponent Behavioral Treatment of Obesity and Overweight in Children and Adolescents: Current State of the Evidence and Research Needs (apa.org)​. Accessed December 8. 2023. 

American Society for Parenteral & Enteral Nutrition (ASPEN). A.S.P.E.N Clinical guidelines: Nutrition support in adult acute and chronic renal failure. JPEN J Parenter Enteral Nutr. ​2017;34(4):366-377. Available at: ​ASPEN | Clinical Guidelines (nutritioncare.org). Accessed December 8, 2023. 

American Society for Parenteral & Enteral Nutrition (ASPEN). A.S.P.E.N Clinical guidelines: Nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr. ​2009;33(5):472-500. Available at: ASPEN | Clinical Guidelines (nutritioncare.org)​. Accessed December 8, 2023. 

American Society for Parenteral & Enteral Nutrition (ASPEN). Fact Sheet: Why nutrition is important: Adult patient with cancer. 2020. Available at: ASPEN | Cancer Care Resources (nutritioncare.org)​. Accessed December 8, 2023. 

Becker P, Carney LN, Corkins MR et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract. 2015 Feb;30(1):147-61.​ Available at:  Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition - Becker - 2015 - Nutrition in Clinical Practice - Wiley Online Library​. Accessed December 11, 2023. ​

Bischoff SC, Bager P, Escher J, et al. ESPEN guideline on Clinical Nutrition in inflammatory bowel disease. Clin Nutr. 2023 Mar;42(3):352-379. ​

Briggs Early K, Stanley K. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet. 2018;118(2):343-353.

Celiac Disease Foundation. Treatment and follow up. Available at: Treatment & Follow-Up | Celiac Disease Foundation​. Accessed December 8, 2023. 

Centers for Disease Control and Prevention. Healthy Living with HIV. 05/20/2021. Available at: Healthy Living | Living With HIV | HIV Basics | HIV/AIDS | CDC​. Accessed December 11, 2023. 

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD): Medical Nutrition Therapy. [CMS website]. 01/01/2022. Available at: NCD - Medical Nutrition Therapy (180.1) (cms.gov)​. Accessed December 8, 2023. 

Crone C, Fochtmann LJ, Attia E, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. Am J Psychiatry. 2023;180(2):167-171. ​

Delahanty LM. Nutritional considerations in type 2 diabetes mellitus. Up to Date. [UpToDate Web site]. 12/05/2023. Available at: http://www.uptodate.com/home/index.html [via subscription only]. Accessed December 8, 2023.​

Delahanty LM, Weinstock RS. Nutritional considerations in type 1 diabetes mellitus. Up to Date. [UpToDate Web site]. 12/14/2022. Available at: http://www.uptodate.com/home/index.html [via subscription only]. Accessed December 8, 2023.

Duarte-Gardea MO, Gonzales-Pacheco DM, Reader DM, et al. Academy of Nutrition and Dietetics Gestational Diabetes Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet. 2018 Sep;118(9):1719-1742. 

ElSayed NA, Aleppo G, Aroda VR, et al. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S68-S96. ​

ElSayed NA, Aleppo G, Aroda VR, et al. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46:S254. 

Feltner C, Peat C, Reddy S et al. Screening for Eating Disorders in Adolescents and Adults: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 212. AHRQ Publication No. 21-05284-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2022.  Available at: Bookshelf_NBK578988.pdf (nih.gov)​. Accessed December 8, 2023. 

Franz MJ, MacLeod J, Evert A, et al. Academy of Nutrition and Dietetics Nutrition practice guideline for type 1 and type 2 diabetes in adults: systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process. J Acad Nutr Diet. 2017;117:1659-1679.

Gater DR, Bauman C, Cowan R. A Primary Care Provider's Guide to Diet and Nutrition After Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2020;26(3):197-202.

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2024. Available at: 2024 GOLD Report - Global Initiative for Chronic Obstructive Lung Disease - GOLD (goldcopd.org)​. Accessed December 11, 2023. ​​

Henry BW, Ziegler J, Parrott JS, Handu D. Pediatric Weight Management Evidence-Based Practice Guidelines: Components and Contexts of Interventions. J Acad Nutr Diet. 2018 Jul;118(7):1301-1311.

Hoelscher DM, Brann LS, O'Brien S, Handu D, Rozga M. Prevention of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews. J Acad Nutr Diet. 2022 Feb;122(2):410-423.e6. Erratum in: J Acad Nutr Diet. 2022 Apr;122(4):882. 

Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017 Apr;23(Suppl 2):1-87. ​​

Johnson MJ, Pearson F, Emm A, et al. Developing a new screening tool for nutritional risk in neonatal intensive care. Acta Paediatricia 2015;104:e90-e93.​​​

Kitzmiller JL, Block JM, Brown FM, et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care. 2008;31(5):1060-1079. 

Kossoff EHW. Ketogenic dietary therapies for the treatment of epilepsy. Up to Date. [UpToDate Web site]. 10/17/2023. Available at: http://www.uptodate.com/home/index.html [via subscription only]. Accessed December 11, 2023. ​

Kramer H, Jimenez EY, Brommage D, et al. Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. J Acad Nutr Diet. 2018;118(10):1958-1965.

Kuehneman T, Gregory M, de Waal D, Davidson P, Frickel R, King C, Gradwell E, Handu D. Academy of Nutrition and Dietetics Evidence-Based Practice Guideline for the Management of Heart Failure in Adults. J Acad Nutr Diet. 2018;118(12):2331-2345. 

Kuhn MA, Gillespie MB, Ishman SL, et al. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg. 2023 Apr;168(4):571-592. ​

Lennon SL, DellaValle DM, Rodder SG, Prest M, Sinley RC, Hoy MK, Papoutsakis C. 2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults. J Acad Nutr Diet. 2017 Sep;117(9):1445-1458.e17. 

Liu G, Slater N, Perkins A. Epilepsy: Treatment Options. Am Fam Physician. 2017;96(2):87-96. ​​

Lock J, La Via MC; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-425. 

Marshall NE, Abrams B, Barbour LA, et al. The importance of nutrition in pregnancy and lactation: lifelong consequences. Am J Obstet Gynecol. 2022; 226:607. 

McDonald CM, Alvarez JA, Bailey J, Bowser EK, et al. Academy of Nutrition and Dietetics: 2020 Cystic Fibrosis Evidence Analysis Center Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet. 2021 Aug;121(8):1591-1636.e3.

Morris SF, Wylie-Rosett J. Medical Nutrition Therapy: A Key to Diabetes Management and Prevention. Clin Diabetes. 2010;28(1):12-18. 

Mueller C, Compher C, Ellen DM; American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. clinical guidelines: Nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr. 2011 Jan;35(1):16-24.​ 

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology™. Survivorship: nutrition and weight management. v.1.2023. [NCCN Web site]. 03/24/2023. Available at: nscl.pdf (nccn.org)​ (via subscription only). Accessed December 8, 2023. ​​

National Institute for Health and Clinical Excellence (NICE). Eating disorders: recognition and treatment. [NICE Web site]. May 2017. Available at: Overview | Eating disorders: recognition and treatment | Guidance | NICE​. Accessed December 8, 2023.​

National Institute of Diabetes and Digestive and Kidney Diseases. Collaborate with a registered dietician. Available at: Collaborate with a Registered Dietitian - NIDDK (nih.gov)​. Accessed December 8, 2023. 

​Nekhyludov L, Lacchetti C, Davis NB, et al. Head and neck cancer survivorship care guideline: American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline. J Clin Oncol. 2017 May;35(14):1606-1621. 

O'Donnell TF Jr, Passman MA, Marston WA, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014;60(2 Suppl):3S-59S. 

Perreault L, Burgermaster M. Obesity in adults:behavioral therapy. Up to Date. [UpToDate Web site]. 07/12/2022. Available at: http://www.uptodate.com/home/index.html [via subscription only]. Accessed December 8, 2023. ​

Rhee CM, Kalantar-Zadeh K, Moore LW. Medical Nutrition Therapy for Diabetic Kidney Disease. J Ren Nutr. 2021;31(3):229-232. ​

Sikand G, Handu D, Rozga M, et al. Medical Nutrition Therapy Provided by Dietitians is Effective and Saves Healthcare Costs in the Management of Adults with Dyslipidemia. Curr Atheroscler Rep. 2023;25(6):331-342. 

Society for Adolescent Health and Medicine. Addressing nutritional disorders in adolescents. J Adolesc Health. 2018;63(1):120-123. ​

Society for Adolescent Health and Medicine. Preventing and treating adolescent obesity: A position paper of the Society for Adolescent Health and Medicine. J Adolesc Health. 2016;59(5):602-606. 

US Preventive Services Task Force. Weight loss to prevent obesity-related morbidity and mortality in adults: behavioral interventions. Available at: Recommendation: Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)​. Accessed December 8, 2023. 

US Preventive Services Task Force. Healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: behavioral counseling interventions. Available at: Recommendation: Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling Interventions | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)​​. Accessed December 8, 2023. 

Vasile FC, Preda A, Ștefan AG, et al. An Update of Medical Nutrition Therapy in Gestational Diabetes Mellitus. J Diabetes Res. 2021 Nov 18:5266919.​

Ward M, Druss B. Lifestyle interventions for obesity and overweight patients with severe mental illness. [UpToDate Web site]. 04/06/2022. Available at: http://www.uptodate.com/home/index.html [via subscription only]. Accessed December 12, 2023.​

White JV, Guenter P, Jensen G, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr​. 2012;36(3):275-283. ​​​
​
Zera C, Brown FM. Pregestational (preexisting) diabetes mellitus: antenatal glycemic control. Up to Date. [UpToDate Web site]. 10/30/2023. Available at: https://www.wolterskluwer.com/en/solutions/uptodate [via subscription only]. Accessed December 8, 2023. ​​​

Coding

CPT Procedure Code Number(s)
97802, 97803, 97804
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
N/A
HCPCS Level II Code Number(s)
G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes

S9449 Weight management classes, nonphysician provider, per session​

S9452 Nutrition classes, nonphysician provider, per session

S9470 Nutritional counseling, dietitian visit​

THE FOLLOWING CODE REPRESENTS GROUP MEDICAL NUTRITION THERAPY; INDIVIDUAL MEMBER BENEFITS MUST BE VERIFIED:

G0271 Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (two or more individuals), each 30 minutes
Revenue Code Number(s)
N/A​

Coding and Billing Requirements

Policy History

Revisions From 10.00.04:
01/01/2025This policy will become effective 01/01/2025.

This new policy has been developed to​ communicate the Company's coverage ​position and medical necessity criteria for Medical Nutrition Therapy (MNT)/Nutrition Counseling.  A new policy number, 10.00.04, has been issued for this policy topic. 

1/1/2025
1/1/2025
10.00.04
Medical Policy Bulletin
Commercial
No