Registered Dietitians (RDs) and Registered Dietitian Nutritionists (RDNs) can enroll in Medicare Part B to provide Medical Nutrition Therapy (MNT) — but coverage is narrower than many dietitians expect. Understanding the scope before enrolling prevents billing compliance problems.
Enrollment basics
- Registered Dietitian or Registered Dietitian Nutritionist credential (Commission on Dietetic Registration)
- State licensure or certification as required by state law
- Completion of an accredited dietetics program and supervised practice
- Type 1 NPI (individual)
- Enrollment via CMS-855I or PECOS
What Medicare covers: Medical Nutrition Therapy
Medicare Part B covers MNT only for beneficiaries with:
- Type 1 or Type 2 diabetes
- Chronic kidney disease (CKD) — defined as GFR 13–50 mL/min/1.73m² (pre-dialysis; patients on dialysis receive nutrition services under the dialysis composite rate, not as MNT)
- Post kidney transplant (within 36 months of transplant)
Coverage does not extend to: obesity, heart disease, hypertension, cancer, gastrointestinal conditions, or any other condition, regardless of how clear the nutritional need is.
Physician referral required
Unlike clinical psychologists or NPs, dietitians must have a physician or qualified NPP referral before providing MNT services. Medicare will not pay for MNT without documentation of the referral.
The referring provider must have a treating relationship with the beneficiary and must document the medical necessity for MNT.
MNT covered services
- G0270 — MNT reassessment and subsequent intervention (individual), per 15 minutes
- G0271 — MNT group therapy (2 or more individuals), per session
- 97802 — Medical nutrition therapy, initial assessment and intervention, per 15 minutes
- 97803 — MNT re-assessment and intervention, per 15 minutes
- 97804 — Group MNT (2 or more individuals), per 30 minutes
Annual coverage limits:
- Year 1 of MNT: 3 hours covered
- Subsequent years: 2 hours covered
- Additional hours: must be ordered by a physician as medically necessary; covered if documented
What dietitians cannot bill under Medicare
- Nutrition counseling for conditions not listed above
- Wellness or preventive nutrition services (except as part of the Medicare Annual Wellness Visit, which is physician-billed)
- Nutrition services for patients on dialysis (covered under composite rate)
- Obesity counseling independently (the Intensive Behavioral Therapy for Obesity is a primary care service, not a dietitian-billed service under current coverage)
⚠️ Risk flag: Billing MNT for conditions other than diabetes and kidney disease is a top audit target for dietitians. The diagnosis code on the claim must match one of the covered conditions — a claim with a primary diagnosis of hypertension and no diabetes/CKD diagnosis will deny.
Group practice and outpatient settings
RDs often work within physician practices, hospital outpatient departments, or dietitian-owned practices. If billing under a group NPI, you’ll need a CMS-855R to reassign your billing. Hospital outpatient department billing for MNT goes through the facility’s Part A MAC, not the Part B MAC.
Key applications
- CMS-855I — individual RD enrollment
- CMS-855R — reassignment to group or hospital system
Ask Mae if you have questions about MNT coverage requirements or how to document the physician referral.