Mountain State Medical Policy Bulletin
Section: Visits
Number: V-44
Topic: Medical Nutrition Management Services (MNT)
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 09/2005

General Policy Guidelines

Indications and Limitations of Coverage

When reported separately, charges for medical nutrition therapy (97802, 97803, 97804, G0270, G0271) should be combined with and processed under the appropriate medical visit procedure codes. If MNT is the only service performed, it will be reimbursed in accordance with the member's medical care benefits.

See Medical Policy Bulletin Z-27 for information on eligible providers.

See Medical Policy Bulletin G-24 for information on the treatment of obesity.

See Medical Policy Bulletin E-15 for information on Diabetic Services and Supplies.

Description

Medical Nutrition Therapy (MNT) (97802, 97803, 97804, G0270, G0271) is an important part of prevention and treatment of many diseases and conditions. MNT is the assessment of the patient’s nutritional status followed by therapy. The overall goal of MNT is to assist the patient in making changes in his/her nutrition and exercise habits leading to improved health through optimal nutrition.

A MNT assessment may include the review and analysis of the following:

  1. Medical, nutrition, and medication histories
  2. Physical examination
  3. Anthropometric measurements
  4. Laboratory test values

Medical Nutrition Therapy (MNT) can include the following:

  1. Diet modification
  2. Counseling and education
  3. Disease self-management skills training
  4. Education/Instruction of specialized therapies such as medical foods, intravenous, or tube feedings

Procedure Codes

978029780397804G0270G0271 

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

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Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.