Medical Nutrition Therapy Benefit Quick Reference Guide
Medical Nutrition Therapy (MNT) provided by a Registered Dietitian (RD) is a covered benefit for all lines of business for Alliance members that meet qualifying conditions or are deemed at nutritional risk.
Prior authorization is required for all MNT services. Prior authorizations can be requested through the Provider Portal by utilizing the following:
|Authorization Subclass||Rehab Therapies|
Providers offering MNT to Alliance members should use the following codes for authorizations and claims payments:
|CPT-4 Code 97802||MNT, initial assessment and intervention, individual, face-to-face with patient, each 15 minutes|
|CPT-4 Code 97803||MNT, re-assessment and intervention, individual, face-to-face with patient, each 15 minutes|
|CPT-4 Code 97804||MNT, group (2 or more individual[s]), each 30 minutes|
|CPT -4 Code G0270||MNT: reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes|
|CPT-4 Code G0271||MNT, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes|
|HCPC Code S9470||Nutritional Counseling, dietitian visit, each 15 minutes|
Annual MNT coverage is a maximum of 3 hours for the first calendar year and 2 hours per calendar year in subsequent years.
|Adults (>18 years) with a medical diagnosis deeming them to be “At Nutrition Risk” requiring a special or restrictive diet, including but not limited to:|
|Children (0-18 years) with a medical diagnosis deeming them to be “At Nutrition Risk” requiring a special or restrictive diet, including but not limited to:|
- The Alliance does not approve MNT for diagnoses of diabetes or prediabetes without a qualifying comorbidity. All eligible members with a diagnosis of diabetes or prediabetes are eligible to access comprehensive individual and group education through an Alliance-approved education provider. The Alliance offers Diabetes Self- Management Education (DSME) and the Diabetes Prevention Program (DPP). Some Alliance-approved education providers may have age restrictions and members with other health coverage must utilize all benefits provided through their primary insurer before utilizing Alliance benefits.
- The Alliance does not cover MNT for adult weight management with a diagnosis of obesity without a qualifying comorbidity. Members ages 18 and older that have a diagnosis of obesity and have a BMI of 30 or above are eligible for the Alliance Wellness that Works Support Program (WWSP). The WWSP is a one-time benefit and only available for members who have Alliance as a primary insurance.
The Alliance also offers a Healthier Living program (HLP) which is a six-week series of self-management workshops that focus on health, wellness, and problems, that are common to individuals suffering from any chronic conditions
For further information regarding these programs please call the Alliance Health Education line 800-700-3874 ext. 5580.
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