CPT Code 97802: Medical Nutrition Therapy, Initial Assessment

What is medical nutrition therapy, initial assessment (CPT 97802)?

CPT 97802 is part of the Current Procedural Terminology (CPT) codes system developed by the American Medical Association to provide standardized codes for reporting medical services. Specifically, CPT code 97802 refers to medical nutrition therapy (MNT)—the initial assessment and intervention, individual, face-to-face with the established patient, each 15 minutes. This code allows registered dietitians and qualified nutrition professionals to bill for the first session of nutrition therapy where a patient’s nutritional status, medical history, and dietary intake are evaluated.

Medical nutrition therapy is a targeted approach that supports patients with chronic conditions such as diabetes, renal disease, cardiovascular issues, obesity, and eating disorders. During this initial assessment, the dietitian gathers detailed background, assesses clinical data, and creates a personalized treatment regimen to improve health outcomes. The focus is on addressing the medical necessity of the intervention by aligning nutritional strategies with the patient's medical condition and physician referrals.

Unlike some procedure codes used for general wellness visits, CPT 97802 is time-based, meaning providers bill per 15-minute increments of direct face-to-face time with the individual patient. The initial visit may only be billed once per calendar year, unless the patient has not been seen for over a year or there has been a significant change in the patient's medical diagnosis or condition. For subsequent visits, CPT code 97803 is used for reassessment and intervention.

This initial session lays the foundation for effective nutrition counseling and intervention. Healthcare professionals rely on MNT to help patients make informed dietary decisions and successfully manage their medical conditions through evidence-based guidance.

CPT code 97802 documentation requirements

Accurate documentation is essential when submitting insurance claims for CPT code 97802. Healthcare providers must ensure that records demonstrate the medical necessity of the services provided and meet payer expectations for proper insurance reimbursement. Documentation should reflect that the encounter was part of medical nutrition therapy MNT, not general health advice.

Key documentation requirements for nutrition therapy initial assessment include:

• Date of service and total face-to-face time spent with the individual patient.
• A thorough assessment and intervention individual report covering:
  • Patient’s medical condition and medical diagnosis.
  • Relevant health history, current treatment regimen, lab results, and dietary intake.
  • Assessment of nutritional status using clinical markers.
• Clear identification of nutrition-related problems and specific care needs.
• Nutrition goals created collaboratively with the patient and, when applicable, the treating physician or referring physician.
• Description of the intervention strategies, such as:
  • Dietary adjustments (including approaches like the ketogenic diet).
  • Behavioral counseling and nutritional counseling.
  • Education about meal planning and nutrient management.
• A written care plan summarizing recommendations is shared with the patient.
• Documentation confirming that services were MNT services provided by a registered dietitian or other qualified nutrition professional.
• Note that only face-to-face time counts toward billing. Time spent on charting, reviewing records, or patient follow-up via phone or email does not count.

Maintaining comprehensive documentation helps support claims submission and reduces the risk of denials by private insurance payers, many private insurance payers, or Medicare.

CPT code 97802 billing guidelines

Understanding the billing process for CPT 97802 ensures accurate reporting and proper insurance reimbursement. Such CPT codes describe what was done and is used by dietitians and nutrition professionals. Therefore, it follows specific rules that healthcare providers must adhere to for compliance.

CPT code 97802 is billed per 15-minute increments of face-to-face time.

• At least 8 minutes of direct new patient contact is required to bill one unit.
• Example: A 60-minute session would equal four units.

Practitioners should also use one line per CPT code when submitting insurance claims, often through the CMS-1500 form. Include accurate diagnosis codes that demonstrate the medical necessity of the nutrition therapy. Common examples:

• Diabetes mellitus.
• Chronic conditions like hypertension or renal disease.
• Obesity.

For Medicare patients, coverage applies to individuals with diabetes, chronic kidney disease, or post-kidney transplant status. It also requires a physician referral from the treating physician and allows up to 3 hours in the initial calendar year and 2 hours in the same calendar year for subsequent intervention.

Providers must also be cautious of the most common CPT codes billing mistakes:

• Using 97802 instead of CPT code 97803 for follow-ups.
• Incorrect unit calculation when time spent is less than 8 minutes.
• Billing MNT and Diabetes Self-Management Training (DSMT) on the same day without confirming payer guidelines.

• Verify policies with private insurers, Medicare, and insurance companies, as requirements may differ based on location and payer.

Adhering to these billing guidelines helps avoid delays, supports accurate reimbursement, and ensures compliance with standardized codes across healthcare systems.

Related CPT and G codes for medical nutrition therapy

Here are the key medical nutrition therapy (MNT) codes commonly used for physician services, including initial assessment, follow-ups, and group sessions:

• CPT 97802: Initial assessment and intervention, individual, 15 minutes per unit. The first nutrition therapy initial assessment session for MNT was conducted face-to-face with the individual patient.
• CPT 97803: Individual reassessment and intervention, 15 minutes per unit. Subsequent intervention or follow-up visits after the initial session adjust the care plan based on the patient's medical condition and progress.
• CPT 97804: Group medical nutrition therapy (2 or more individuals), 30 minutes per unit. Group visits or sessions where MNT services are delivered in a group setting..
• G0270 (Medicare-specific code): Medicare MNT reassessment and intervention, individual, 15 minutes per unit. For individual Medicare patients after a second referral in the same calendar year, requiring additional MNT services.
• G0271 (Medicare-specific code): Group MNT reassessment and intervention for Medicare patients, 30 minutes per unit. Group reassessment or subsequent intervention for Medicare patients receiving MNT in a group session.