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Guide To CPT Code 97802 And CPT Code 97803

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CPT codes are the shortened form of Current Procedural Technology. CPT codes show what treatment you provided for your client. They include every type of service or procedure (tests, evaluations, etc.). The CPT codes that you include on your insurance billing claim or superbill, are the services your client could be reimbursed for. Understanding which CPT codes you can use to bill for nutritional services is essential to ensure that you are reimbursed for your time through your client’s insurance payer. 

In this article, we explain CPT codes, identify the most common CPT codes for nutritional services (97802 and 97803), and walk through how to enter CPT codes within an insurance billing claim or superbill. 

CPT® Codes 97802 and 97803 for Nutrition Services

Current Procedural Terminology are set by the American Medical Association, and offer doctors and healthcare professionals a uniform language for coding medical services and procedures. AMA’s evidenced-based CPT codes have generally been adopted across Insurance Payers, to streamline reporting, increase accuracy and efficiency. 

All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have a common understanding across the clinical healthcare paradigm.

Note: The CPT code describes what was done during the patient consultation, including diagnostic and medical procedures, while the ICD code identifies a diagnosis and describes a disease or medical condition. You’ll list the ICD code separately on the CMS1500 claim. Do not confuse CPT codes with ICD codes! 

The three most common medical nutrition therapy (MNT) codes that dietitians use on claims are listed below. Public insurers, like Medicare and Medicaid, as well as private insurance carriers, can use these CPT codes.

  • 97802 – For an initial assessment, face-to-face, 15 minutes per unit
  • 97803 – For a follow up visit or reassessment, face-to-face, 15 minutes per unit
  • 97804 – For a group visit (2 or more individuals), 30 minutes per unit

When creating a superbill or filling out a CMS 1500 form, you will also have to specify the number of units and your fee per unit. CPT codes 97802 and 97803 should be unit priced; four units = 60 minutes, and six units = 90 minutes.

For many private insurance payers, up to 6 units may be billed with 97802.

Where to Indicate CPT Codes 97802 and 97803 When Billing Insurance

Properly including your CPT code(s) within your claim is critical. Any claim that is incomplete, or has errors, will be denied by the insurance provider. Ensuring that you’ve identified the right CPT code to include, and properly documenting the code, will reduce your claims rejections. 

The CMS 1500 is an insurance claim form for non-institutionalized healthcare providers, such as private practice nutrition and wellness professionals. Initially created by Medicare, this claim form has been adopted across private insurance payers as the standardized format for submitting insurance claims. 

Originally a paper form (and still widely available at office suppliers like Staples), claims submission has largely transitioned to electronically submitted versions of the claim form. If you were to complete the physical form, or review your electronically completed version of the CMS 1500 form, section 24d indicates where your CPT code(s) should be listed. 

Adding CPT Codes to a CMS 1500 Printed Form 

The majority of insurance payers, including Medicare, accept electronic CMS 1500 forms. You may not have need to often complete an actual physical form, however, when reviewing your claim form it’s important to know where the CPT codes should be listed. 

You’ll find the field to enter CPT codes in field 24D “Procedures, Services, or Supplies.” There is space to list several CPT codes on a single claim, if you provided multiple services. However, when using CPT codes 97802 or 97803, you’ll only indicate one of these codes. To the right of this field, on the same line, you’ll want to review that the diagnosis pointer, charges, and units are all correctly completed. Claims that are incorrect will be denied, and you’ll need to resubmit a corrected version of the form. 

Adding CPT Codes Through an Electronic Billing Platform

If electronically using an EHR and/or billing platform, such as Healthie, to create your claim, you’ll be prompted to select your CPT codes as you fill out the claim details. You’ll also need to complete fields indicating the number of units for the service, and your fee. The billing platform will then autofill the electronic version of a CMS 1500 form. Quite typically, you will then electronically upload your claim to a clearinghouse, such as Office Ally, to be scrubbed (checked for errors) and submitted to the insurance payer. 

What if My Insurance Claim Was Denied with CPT Codes 97802 or 97803? 

One of the challenging aspects regarding insurance billing is the frequency of denied claims. If your claim was denied, there is typically an error reason communicated. It could be an error on the insurance provider’s end, and you may need to resubmit the claim as-is. As a next step, you may want to confirm which diagnosis codes your client is covered for. You could try resubmitting the claim with a different diagnosis code, but list the same CPT codes, 97802 or 97803. 

To learn more about processing insurance claims for wellness services through Healthie, start your free trial today or email us at hello@gethealthie.com.

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