Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Physician Bulletin 86 July 2007 TO: Physicians Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Medical Nutrition Therapy and Diabetes Self-Management Training MNT/DSM Coverage Effective for dates of service on or after July 1, 2007, MassHealth is reimbursing physicians for medical nutrition therapy (MNT) and diabetes self-management training (DSMT). Members of all ages enrolled in MassHealth Standard, Prenatal, CommonHealth, and Family Assistance for persons with HIV, and members who get direct coverage (not premium assistance) for MassHealth Basic, Essential, and Family Assistance forchildren are eligible to receive MNT and DSMT services described in this bulletin. These changes will be further reflected in revised regulations to be issued within the coming months. Changes described in this bulletin, however, are effective July 1, 2007, regardless of the effective date of the regulations. Additional information is provided below. Medical nutritional therapy is nutritional diagnostic therapy and counseling services for the purpose of management of a medical condition. MNT services are payable when provided to eligible MassHealth members by the following providers: -physicians; -dietitians/nutritionists licensed by the Massachusetts Division of Professional Licensure, and the Board of Registration of Dieticians and Nutritionists; -mid-level practitioners credentialed by the Commission on Dietetic Registration (CDR) (e.g., nurse-midwives, nurse practitioners, registered nurses, and physician assistants); or-other health-care providers licensed by the Massachusetts Division of Professional Licensure, and the Board of Registration of Dietitians and Nutritionists, with specific training in the provision of nutritional counseling as provided in 42 U.S.C. 1395x(vv)(2). (continued on back) MassHealth Physician Bulletin 86 July 2007 Page 2 MNT/DSM Coverage (cont.) Diabetes self-management training is diabetes self-management training and education, which may include medical nutrition therapy, and is furnished to an individual with pre-diabetes or diabetes. DSMT services are payable when provided to eligible MassHealth members by the following providers: -physicians; -dietitians/nutritionists licensed by the Massachusetts Division of Professional Licensure, and the Board of Registration of Dietitians and Nutritionists; -mid-level practitioners credentialed by the National Certification Board of Diabetes Educators (NCBDE) (e.g., nurse mid-wives, nurse practitioners, registered nurses, and physician assistants); or -other health-care providers with specific training in the provision of DSMT as provided in 42 U.S.C. 1395x(qq)(2). MNT and DSMT services are payable to a physician when provided by mid-level practitioners under the supervision of that physician. Supervising physicians must ensure that mid-level practitioners possess the appropriate credentials and training. MNT and DSMT services are payable to nurse-midwives and nurse practitioners enrolled independently with MassHealth. Covered Service Codes The following codes are covered for MNT services for dates of service on or after July 1, 2007: 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes. 97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes. 97804 Medical nutrition therapy; group (2 or more individuals), each 30 minutes G0270 Medical nutrition therapy; 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. (continued on next page) MassHealth Physician Bulletin 86 July 2007 Page 3 Covered Service Codes (cont.) G0271 Medical nutrition therapy, 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. The following codes are covered for members with a diagnosis of diabetes for DSMT services for dates of service on or after July 1, 2007: G0108 Diabetes outpatient self-management training services, individual, per 30 minutes G0109 Diabetes outpatient self-management training services, group session (2 or more individuals), per 30 minutes Rates for these services can be found on the Division of Health Care Finance and Policy (DHCFP) Web site, at www.mass.gov/dhcfp. The specific regulation title is 114.3 CMR 17.00: Medicine. For MassHealth members receiving services under any of the MNT or DSMT codes above on the same date of service as an office visit, physicians may bill both office-visit and MNT/DSMT codes. Members enrolled in the PCC Plan do not need a PCC referral for MNT or DSMT services. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.