CPT codes, or Current Procedural Technology codes are used to classify medical services and procedures for billing and reimbursement. If you’re a dietitian or nutritionist, knowing which CPT codes apply to nutrition counseling is important to ensure proper reimbursement from insurance payers. 

In this guide on how to correctly use CPT code 97802 and CPT code 97803, we will cover:

• What CPT codes are and how they work
• The most common CPT codes for nutrition counseling and medical nutrition therapy (MNT), including 97802 and 97803
• How to correctly enter CPT codes on a Superbill or insurance claim form
• Troubleshooting insurance claim denials for nutrition services

Accurate coding is the key to ensuring timely and proper reimbursement as well as avoiding claim denials. Let’s get started. 

What are CPT codes for nutrition counseling? 

CPT codes are used by healthcare providers, including dietitians and nutritionists, to accurately bill for services. These codes are established and reviewed annually by the American Medical Association and provide a standardized language for coding medical services and procedures to insurance payers. CPT codes for nutrition counseling ensure that clinicians receive reimbursement for their time and expertise. 

AMA’s evidence-based CPT codes are widely accepted by private insurance companies, Medicare, and Medicaid, helping to streamline insurance billing, improve coding accuracy, and facilitate efficient claim processing. All nutritionist CPT codes and dietary counseling CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. These standardized codes create a universal language across the healthcare ecosystem, enabling collaboration among providers and ensuring clarity in billing and documentation. 

CPT codes versus ICD codes: what's the difference? 

While CPT codes describe the services provided during the patient visit, including diagnostic and medical procedures, ICD codes identify a patient’s diagnosis or medical condition. 

When submitting an insurance claim, both CPT and ICD codes will be included:

CPT codes: Indicate the specific services performed. 

• For example: 97802 CPT code for an initial assessment

ICD codes: Provide a justification for why the service was necessary by documenting a medical condition. 

• For example, E11.9 for diabetes

CPT codes 97802 and 97803 for nutrition counseling services

When billing for nutrition counseling services, dietitians and nutritionists most commonly use CPT code 97802 and CPT code 97803. These codes are essential for medical nutrition therapy and ensure reimbursement from insurance payers, including private insurers, Medicare, and Medicaid. 

CPT code 97802 – This code is used for an initial assessment for medical nutrition therapy. This code is specifically for face-to-face nutrition counseling, lasting 15 minutes per unit.

CPT code 97803 – This code is used for follow-up nutrition counseling sessions. This code is specifically used for face-to-face reassessment or intervention, also lasting 15 minutes per unit. 

In addition, CPT code 97804 is used for group nutrition counseling sessions (2 or more individuals) and is billed in 30 minute increments.

How to bill CPT code 97802 and CPT code 97803 for nutrition services

Accurately billing CPT codes for nutrition services is crucial for insurance reimbursement. When submitting a claim, providers must specify the number of units and the fee per unit to ensure proper processing.

Understanding units for CPT code 97802 and CPT code 97803

It’s important to ensure that you’re not just submitting the correct code, but also including the accurate number of units for each code as this will drastically affect your reimbursement. 

• CPT code 97802 (initial assessment) and CPT code 97803 (follow-up visits) are unit-based.
• One unit = 15 minutes of service.
• Four units = 60 minutes, and six units = 90 minutes per session.
• Many private insurance payers allow up to six units per visit when billing 97802 CPT code for an initial assessment.

Submitting CPT codes on the CMS 1500 insurance claim form

The CMS 1500 form is used by private practice dietitians and nutrition professionals to submit insurance claims. Originally developed by Medicare, it is now widely accepted by private insurance payers as well. 

While CMS 1500 forms are still available in paper format, most claims are now submitted electronically.

Steps for filling out a CMS 1500 form:

• Locate field 24D–”Procedures, Services, or Supplies”: This is where you can enter CPT code 97802 or CPT code 97803.
• Enter only one CPT code per line: If multiple services were provided, list them on separate lines.
  
  • Note that a visit can only qualify for code 97802 or code 97803, not both. 
• Specify the number of units: Ensure that your time-based units match the duration of service provided.
• Verify the ICD-10 Diagnosis code: While the CPT code describes the service, the ICD-10 code justifies the need for treatment.
• Double-check codes and insurance information: Review and verify the claim is filled out accurately before submitting to reduce claim denials. 

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Adding CPT codes through an electronic billing platform

Manually filing out CMS 1500 forms and submitting claims can be both time-consuming and more likely to incur errors. Using a digital EHR and billing platform, such as Healthie, can streamline this process and reduce administrative burden.

With Healthie’s integrated billing system, you can: 

• Easily select CPT codes: The Healthie platform was built for nutritionists and dietitians, and allows clinicians to easily choose CPT codes to add to claims. 
• Automate claim generation: Healthie’s all-in-one EHR, practice management, and patient engagement platform can autopopulate form fields, reducing manual errors. 
• Set units and fees: Enter the number of billed units per session, and Healthie can calculate charges automatically.
• Minimize errors with claim scrubbing: Healthie integrates with clearinghouses such as ClaimMD and OfficeAlly, allowing you to send claims more easily to insurance payers. 

Billing doesn’t have to be a headache. With the right tools you can bill quickly and accurately to reduce denials and be reimbursed promptly.