What is the CPT Code for Nutrition Evaluation?

December 14, 2025 •

3 min read

According to the Centers for Medicare & Medicaid Services, Medical Nutrition Therapy (MNT) is a covered service for specific conditions. For providers, understanding what is the CPT code for nutrition evaluation is essential for proper billing and reimbursement. This comprehensive guide breaks down the primary codes used for nutrition assessments and therapy.

Quick Summary

The CPT code for an initial medical nutrition evaluation is 97802, used for the first face-to-face assessment. Subsequent individual reassessment and intervention sessions are billed under code 97803, while group sessions use code 97804.

Key Points

CPT Code 97802 is for Initial Assessment: This code is used for the first face-to-face medical nutrition therapy evaluation and intervention with an individual patient.
CPT Code 97803 is for Follow-up Visits: Subsequent individual reassessment and intervention sessions are billed under code 97803, also in 15-minute units.
CPT Code 97804 is for Group Therapy: Group medical nutrition therapy sessions involving two or more patients are coded as 97804 and billed in 30-minute units.
Codes are Time-Based: The codes 97802 and 97803 are billed in 15-minute increments, requiring accurate time tracking for reimbursement.
Pair CPT with ICD-10 Codes: Claims must include both the CPT code for the service and a relevant ICD-10 diagnosis code to establish medical necessity.
Documentation is Crucial: Thorough documentation of the patient's assessment, care plan, and time spent is essential to prevent claim denials.
Payer Policies Vary: Providers should always verify patient-specific insurance coverage and check for any payer-specific billing rules or limitations.

CPT Code 97802: The Foundation of Nutrition Evaluation

The primary CPT (Current Procedural Terminology) code for a new patient's initial nutrition evaluation is 97802. This code, defined as Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes, covers a thorough evaluation of the patient's nutritional status, including their medical history, lifestyle, and diet. This assessment forms the basis for a personalized nutrition care plan.

Key Components of an Initial Assessment

An initial nutrition evaluation using CPT code 97802 includes several critical steps performed by a registered dietitian or qualified professional:

Assessment: Reviewing diet, lifestyle, and medical conditions.
Diagnosis: Identifying specific nutritional issues.
Goal Setting: Collaborating with the patient to set realistic goals.
Education: Providing guidance on dietary changes and meal planning.
Care Plan: Developing a plan for ongoing therapy.

Time-Based Billing for Nutrition Evaluation

CPT code 97802 is billed in 15-minute units. For example, a 60-minute session is billed as four units. Accurate time documentation is vital for proper reimbursement. While many private insurers allow billing multiple units, Medicare may have annual limits.

Subsequent Visits and Group Therapy: Expanding the Code Set

Other CPT codes are used for follow-up and group sessions.

CPT Code 97803: Reassessment and Intervention

Individual follow-up sessions after the initial evaluation are billed using CPT code 97803, which covers reassessment and intervention. These sessions monitor progress, address challenges, and adjust the nutrition plan. Like 97802, this code is billed in 15-minute units.

CPT Code 97804: Group Medical Nutrition Therapy

CPT code 97804 is used for MNT sessions with two or more individuals. These group sessions are billed in 30-minute units and are effective for educating patients with similar health conditions.

Importance of Accurate ICD-10 Codes

Correct CPT codes must be paired with accurate ICD-10 (International Classification of Diseases, Tenth Revision) diagnosis codes to demonstrate medical necessity. For instance, a patient with Type 2 Diabetes (ICD-10 range E11) receiving MNT (CPT 97802) requires both codes for reimbursement.

Comparison of MNT CPT Codes


Feature	CPT Code 97802	CPT Code 97803	CPT Code 97804
Service Type	Initial Assessment & Intervention	Reassessment & Intervention	Group Therapy
Patient Count	Individual, face-to-face	Individual, face-to-face	Two or more individuals
Billing Unit	Each 15 minutes	Each 15 minutes	Each 30 minutes
Purpose	Comprehensive evaluation, plan development	Monitoring progress, adjusting plan	Group education and support
Usage Frequency	Typically once per year, per patient (per condition).	Used for all subsequent individual visits.	Used for all group sessions.
Provider	Registered Dietitian or qualified professional.	Registered Dietitian or qualified professional.	Registered Dietitian or qualified professional.

Maximizing Reimbursement for Nutrition Evaluation

Successful billing for nutrition evaluations requires careful documentation and understanding payer rules. Demonstrating medical necessity is key. Document the session duration, patient history, recommendations, and goals. Inadequate documentation is a common reason for denials. Verify insurance coverage and requirements before sessions. Telehealth services may also be billable with specific modifiers.

Steps for a Successful Claim Submission

Obtain Referral: A physician referral is often required for MNT coverage, especially by Medicare.
Verify Eligibility: Confirm insurance coverage and check for preauthorization needs.
Document Thoroughly: Record session details, interventions, and medical necessity.
Assign Accurate Codes: Pair the correct CPT code (97802, 97803, or 97804) with the appropriate ICD-10 code.
Submit Claim: Use the standard CMS 1500 form.

Common Mistakes to Avoid When Billing

Incorrect Code Usage: Using 97802 for a follow-up instead of 97803 can lead to denials.
Poor Documentation: Lack of detailed notes can result in claim rejections.
Billing Incorrect Units: Inaccurate calculation of time can lead to underpayment.
Ignoring Payer Policies: Failure to follow specific insurance company rules can cause issues.
Missing ICD-10 Codes: Claims without supporting ICD-10 diagnosis codes are likely to be denied.

Conclusion

For nutrition professionals, understanding CPT codes for nutrition evaluation, particularly 97802 for initial assessments, 97803 for follow-ups, and 97804 for group therapy, is crucial for a thriving practice. Accurate coding, combined with meticulous documentation and knowledge of ICD-10 codes and payer policies, is essential for maximizing reimbursement and minimizing claim denials. This proficiency allows providers to deliver vital Medical Nutrition Therapy effectively, supporting patient health outcomes and building a financially stable practice.

Frequently Asked Questions

CPT code 97802 is for the initial assessment and intervention of a new patient for medical nutrition therapy. CPT code 97803 is for all subsequent reassessment and intervention visits for that same patient.

Generally, registered dietitians and other qualified nutritional professionals are authorized to bill for medical nutrition therapy (MNT) services using these codes. In some cases, other healthcare providers with specific training may also qualify.

CPT code 97802 is billed based on 15-minute units. To bill for a 60-minute session, a provider would bill four units of 97802.

For Medicare and many private insurers, a physician or other authorized healthcare provider referral is required for medical nutrition therapy services to be covered. It is crucial to verify each patient's specific plan requirements.

Generally, CPT code 97802 is intended for the first visit with a patient. However, it can sometimes be used again for a returning patient if there has been a significant change in their diagnosis or treatment plan, and individual payer rules permit it.

For group medical nutrition therapy sessions involving two or more individuals, the correct CPT code to use is 97804.

Comprehensive documentation is essential, including the patient's health history, dietary evaluation, nutritional diagnosis, the care plan developed, and the total time spent during the face-to-face session.