Medicare MNT Order Checklist
Right-the-First-Time Provider & Staff Guide - 2026
5 Every Time + 4 When Applicable3 initial hours → 2 follow-up hours/year → additional pathwayMD/DO referral
EVERY MNT REFERRAL - VERIFY THESE 5 ELEMENTS
1. Qualifying diagnosis. Diabetes mellitus or qualifying renal disease. Maintenance-dialysis services are excluded from the separate renal MNT benefit.
2. MD/DO referral. Medicare MNT referral must be made by a physician, defined for this benefit as an MD or DO.
3. Qualifying diagnosis stated. Identify diabetes or qualifying renal disease on the referral. Including the current ICD-10-CM code is operationally helpful.
4. Physician record supports it. Document the qualifying diagnosis and the physician decision/referral for MNT.
5. Authenticated, dated, NPI available. Authenticate/date the documentation and provide the correct individual physician NPI to the MNT provider.
WHEN APPLICABLE
6. New calendar year? Obtain a new physician referral for follow-up MNT.
7. New episode? Obtain a physician referral for each episode of care.
8. Additional hours? Obtain a second/additional physician referral.
9. Why extra hours? Document a change in diagnosis, condition, or treatment regimen related to diabetes/renal disease that requires a change in MNT.
COPY-READY EXAMPLES
Chart: Patient has [diabetes mellitus / qualifying renal disease]. Medical Nutrition Therapy is medically indicated. Referral for Medicare-covered MNT placed today.
Referral: Refer for Medical Nutrition Therapy for [qualifying diagnosis / ICD-10-CM]. Medicare MNT referral made by MD/DO.
NOT UNIVERSAL NATIONAL MEDICARE MNT REFERRAL REQUIREMENTS
Special CMS MNT form; face sheet; automatic latest office note; recent face-to-face visit solely for MNT; supervising physician specifically; GFR printed on referral; numeric ICD-10 printed on the referral document. A receiving facility may request extra intake information.