Medical Nutrition Therapy — NCD 252 | CMS Coverage Update

CMS modified NCD 252 for Medical Nutrition Therapy, effective January 9, 2026. Here's what billing teams need to do.

The Centers for Medicare & Medicaid Services updated its coverage policy for Medical Nutrition Therapy (MNT) under NCD 252 in its Medicare system. This change clarifies hour-based coverage limits for beneficiaries with diabetes or renal disease and defines how MNT interacts with Diabetes Self-Management Training (DSMT) when both are ordered in the same episode of care. No specific CPT or HCPCS codes are listed in the policy document itself — your MNT billing guidelines must reference the claims processing transmittals linked in the policy.

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Quick-Reference Table

Field	Detail Copy
Payer	CMS (Medicare Part B)
Policy	Medical Nutrition Therapy — NCD 252
Policy Code	NCD 252
Change Type	Modified
Effective Date	January 9, 2026
Impact Level	Medium
Specialties Affected	Registered Dietitians, Nutritionists, Endocrinology, Nephrology, Primary Care
Key Action	Confirm your MNT hour counts per beneficiary per year, and verify that DSMT and MNT are never billed on the same date of service

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CMS Medical Nutrition Therapy Coverage Criteria and Medical Necessity Requirements 2026

NCD 252 is the National Coverage Determination governing Medicare Part B coverage of Medical Nutrition Therapy services. Congress authorized this benefit under Section 1861(s)(2)(V) of the Social Security Act. The original regulations took effect January 2, 2002, under 42 CFR 410.130–410.134.

The CMS medical nutrition therapy coverage policy covers two patient populations: those with a diabetes diagnosis and those with renal disease, as defined at 42 CFR 410.130. If your beneficiary doesn't fall into one of those two categories, Medicare Part B does not cover MNT. Full stop.

First-Year Coverage

In the first year a beneficiary receives MNT, Medicare covers three hours of services. The dietitian or nutritionist decides how many units to bill per day. They just can't exceed the annual cap without a medical necessity determination.

Subsequent-Year Coverage

After the first year, coverage drops to two hours per year. The same rules apply — the provider controls daily unit distribution, but the annual ceiling is two hours.

Additional Hours: The Medical Necessity Exception

This is where your medical necessity documentation really matters. Under 42 CFR 410.132(b)(5), a physician can order additional MNT hours beyond the standard cap. The physician must determine that a change in medical condition, diagnosis, or treatment regimen requires a change in MNT. That determination must be documented and must occur within that episode of care.

Vague documentation won't hold up. "Patient needs more sessions" is not the same as "change in diagnosis requiring revised MNT." Your billing team should confirm the physician's order explicitly references a change in medical condition, diagnosis, or treatment regimen before billing additional hours.

Prior Authorization

The CMS MNT coverage policy does not list a prior authorization requirement for standard covered hours. However, additional hours beyond the annual cap do require a physician order with documented medical necessity. That physician order functions as your authorization — no separate prior auth process is described, but the order must be in the chart before you bill.

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CMS MNT and DSMT Coordination: What the 2026 Policy Update Clarifies

This is the part of the policy that trips up the most billing teams. When a physician determines that both MNT and DSMT are medically necessary in the same episode of care, Medicare covers both — and neither benefit gets reduced.

That's genuinely good news for beneficiaries with diabetes who need both services. Medicare won't cut DSMT hours because MNT was also ordered, or vice versa.

But there's a hard rule buried in that coverage: MNT and DSMT cannot be provided on the same date of service. If your team bills both on the same date, expect a claim denial. Schedule them on separate days, and make sure your scheduling and charge capture systems enforce that separation.

The same physician-order exception applies here. If a change in medical condition, diagnosis, or treatment regimen requires additional MNT hours during an episode that also includes DSMT, the physician must document that change and order the additional hours. Document it the same way you would for a standalone MNT case.

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Coverage Indications at a Glance

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CMS Medical Nutrition Therapy Billing Guidelines and Action Items 2026

The NCD 252 update gives your billing team a clear framework. Here's how to act on it before any claim issues arise.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Medical Nutrition Therapy Under NCD 252

Covered CPT and HCPCS Codes

NCD 252 does not list specific CPT or HCPCS codes in the policy document itself. The applicable medical nutrition therapy billing codes are referenced in CMS claims processing transmittals TN 11272 and TN 11426. Access those documents directly at the links provided in the policy:

• TN 11272: https://www.cms.gov/files/document/r11272cp.pdf
• TN 11426: https://www.cms.gov/files/document/r11426cp.pdf

Do not build your charge capture from the NCD alone. Those transmittals contain the operative billing instructions.

Key ICD-10-CM Diagnosis Codes

NCD 252 does not list specific ICD-10-CM codes. Coverage applies to beneficiaries with a diabetes or renal disease diagnosis as defined at 42 CFR 410.130. Confirm which ICD-10 codes your MAC accepts for MNT claims by reviewing your MAC's local guidance or the claims processing transmittals above.

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