What is CPT code 97803 for Medicare: A Comprehensive Guide

November 18, 2025 •

2 min read

According to the Centers for Medicare & Medicaid Services (CMS), medical nutrition therapy (MNT) is a key part of managing several health conditions, making a clear understanding of what is CPT code 97803 for Medicare crucial for proper provider reimbursement and patient care.

Quick Summary

CPT code 97803 is used for individual, face-to-face reassessment and intervention for Medical Nutrition Therapy (MNT) services covered by Medicare. It must follow an initial assessment billed with CPT code 97802.

Key Points

Purpose: CPT code 97803 is for follow-up, individual, face-to-face reassessment and intervention for Medical Nutrition Therapy under Medicare.
Unit Billing: The service is billed in 15-minute increments, with each unit representing 15 minutes of service.
Distinction from 97802: Unlike 97802, which covers the initial MNT assessment, 97803 is for subsequent visits.
Medicare Coverage: Medicare covers MNT services billed with 97803 for patients with a diagnosis of diabetes or renal disease, following a physician referral.
Telehealth: The service can be provided via telehealth, using appropriate modifiers like '95' to indicate a synchronous audio and video session.
Documentation: Accurate and detailed documentation, including physician orders and clear medical necessity, is essential for proper reimbursement.

Understanding Medical Nutrition Therapy (MNT) Services

Medical Nutrition Therapy (MNT) is a nutritional diagnostic, therapy, and counseling service provided by a registered dietitian or nutrition professional. It is covered by Medicare Part B for specific medical conditions, primarily diabetes and renal disease. For providers to receive reimbursement, accurate billing using the correct Current Procedural Terminology (CPT) codes is essential. While the initial assessment has its own code, 97803 is specifically for subsequent, or follow-up, visits.

The Specifics of CPT Code 97803 for Medicare

CPT code 97803 is defined as: "Medical Nutrition Therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes". This code is used by dietitians and nutritionists for follow-up sessions with an individual patient. It is reported in 15-minute increments. The 'face-to-face' requirement includes both in-person and telehealth visits.

Key components of a 97803 session:

Re-assessment of the patient's nutritional status and progress.
Modification of the existing nutrition care plan.
Ongoing counseling, support, and education.
Coordination of care with other healthcare providers.

Comparing CPT Codes 97802 and 97803

Understanding the distinction between CPT codes 97802 and 97803 is critical for compliant billing. These two codes represent different stages of MNT. The following table highlights the core differences:


Feature	CPT Code 97802	CPT Code 97803
Service Description	Medical Nutrition Therapy; initial assessment and intervention.	Medical Nutrition Therapy; re-assessment and intervention.
Timing	Used for the very first MNT visit with a patient.	Used for all subsequent MNT visits after the initial assessment.
Purpose	To perform a comprehensive initial evaluation and create the initial care plan.	To evaluate progress, adjust the care plan, and provide ongoing education.
Unit Billing	Each 15 minutes.	Each 15 minutes.
Medical Necessity	Requires a physician referral and covered diagnosis for the initial encounter.	Requires a physician referral and covered diagnosis for follow-up.

Medicare Coverage and Requirements for MNT

Medicare coverage for MNT with CPT code 97803 requires a physician referral for patients with diabetes or renal disease. The number of covered hours per year is set by CMS. Documentation must include a physician referral, covered diagnosis, and detailed session notes.

Billing with Modifiers and Telehealth

Telehealth for MNT requires specific modifiers, such as Modifier 95 for synchronous audio-video sessions. Some payers, including Medicare, may require specific place of service codes like POS 10 for telehealth in the patient's home. Keeping up-to-date with payer-specific guidelines is crucial for avoiding claim denials and compliance issues. Learn more about billing for MNT services from providers like 24/7 Medical Billing Services.

Conclusion

CPT code 97803 is vital for billing follow-up Medical Nutrition Therapy for Medicare patients. Accurate use, proper documentation, and adherence to Medicare guidelines, including distinguishing it from 97802 and applying telehealth modifiers, are key to successful reimbursement and compliant billing.

Frequently Asked Questions

CPT code 97803 is used to bill for individual, face-to-face medical nutrition therapy (MNT) reassessment and intervention services for Medicare patients.

CPT code 97802 is for the initial assessment and intervention of MNT, while 97803 is used for all subsequent reassessment and intervention sessions.

Since CPT code 97803 is billed in 15-minute increments, a 30-minute session would be billed as two units of 97803.

No, Medicare coverage for MNT, including services billed with CPT code 97803, is limited to specific conditions, most commonly diabetes and non-ESRD renal disease.

Yes, CPT code 97803 can be billed for telehealth visits. You must use a specific modifier, such as '95' to indicate the service was delivered via interactive audio and video telecommunications.

Providers need a physician's referral, a clear medical necessity linked to a covered diagnosis, and detailed session notes justifying the time and services provided.

Billing incorrectly can lead to claim denials, delayed payments, and potential compliance issues. It is crucial to use CPT code 97802 for the initial assessment and 97803 for subsequent visits.