LCD/NCD Portal

NCD180.1

 

MEDICAL NUTRITION THERAPY

 

Effective Date of this Version

• 10/1/2002

 

Benefit Category

• Medical Nutrition Therapy Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• Section 1861(s)(2)(V) of the Social Security Act authorizes Medicare part B coverage of medical nutrition therapy services (MNT) for certain beneficiaries who have diabetes or a renal disease, effective for services furnished on or after January 1, 2002.

• Regulations for medical nutrition therapy (MNT) were established at 42 CFR §§410.130 – 410.134.

• This national coverage determination establishes the duration and frequency limits for the MNT benefit and coordinates MNT and diabetes outpatient self-management training (DSMT) as a national coverage determination.

 

Indications and Limitations of Coverage

• 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 three hours, of administration.

o Also effective October 1, 2002, basic coverage in subsequent years for renal disease or diabetes is 2 hours.

o The dietitian/nutritionist may choose how many units are administered per day as long as all of the other requirements in this NCD and 42 CFR §§410.130-410.134 are met.

o Pursuant to the exception at 42 CFR §410.132(b)(5), additional hours are considered to be medically necessary and covered if the treating physician determines that 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.

• Effective October 1, 2002, if the treating physician determines that receipt of both MNT and DSMT is medically necessary in the same episode of care,

o Medicare will cover both DSMT and MNT initial and subsequent years without decreasing either benefit as long as DSMT and MNT are not provided on the same date of service.

o The dietitian/nutritionist may choose how many units are performed per day as long as all of the other requirements in the NCD and 42 CFR §§410.130-410.134 are met.

o Pursuant to the exception at 42 CFR 410.132(b)(5), additional hours are considered to be medically necessary and covered if the treating physician determines that 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.

 

Claims Processing Instructions

• TN A-02-115 (Program Memorandum Intermediaries)

• TN AB-02-151 (Program Memorandum Intermediaries/Carriers)

• TN AB-02-059 (Program Memorandum Intermediaries/Carriers)

• TN B-01-48 (Program Memorandum Carriers)

• TN A-03-009 (Program Memorandum Intermediaries)

Coverage Transmittal Link

• http://www.cms.gov/transmittals/downloads/R154CIM.pdf

 

National Coverage Analyses (NCAs)

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Medical Nutrition Therapy Benefit for Diabetes & ESRD (CAG-00097N) opens in new window

 

Medicare NCD Link