5160-8-41 Medical nutrition therapy services.  

  • Text Box: ACTION: Final Text Box: DATE: 04/28/2016 10:59 AM

     

     

     

    5160-8-41                    Medical nutrition therapy services.

     

     

     

    (A)Definitions.

     

    (1)"Medical nutrition therapy" is the use of specific nutrition services to treat an illness, injury, or condition. Medical nutrition therapy services include nutrition assessment, intervention, and counseling.

     

    (2)"Registered dietitian nutritionist" has the same meaning as "registered dietitian" in Chapter 4759. of the Revised Code.

     

    (3)"Licensed dietitian" has the same meaning as "licensed dietitian" in Chapter 4759. of the Revised Code.

     

    (B)Providers.

     

    (1)Rendering providers. The following eligible providers may render a medical nutrition therapy service:

     

    (a) A registered dietitian nutritionist; or

     

    (b) A licensed dietitian.

     

    (2)Billing ("pay-to") providers. The following eligible providers may receive medicaid payment for submitting a claim for a medical nutrition therapy service on behalf of a rendering provider:

     

    (a) An independent registered dietitian nutritionist;

     

    (b) An independent licensed dietitian;

     

    (c) A professional medical group; or

     

    (d)A fee-for-service ambulatory health care clinic.

     

    (C)Coverage. Payment may be made for the following three medical nutrition therapy services listed in "Current Procedural Terminology," published by the American medical association (AMA), http://www.ama-assn.org:

     

    (1) Initial assessment and intervention;

     

    (2) Reassessment and intervention; and

     

    (3) Group counseling.

     

    (D)Claim payment. Payment for a covered medical nutrition therapy service is the lesser of the submitted charge or the amount shown in appendix DD to rule 5160-1-60 of the Administrative Code.

     

     

     

    5160-8-41

     

     

     

     

    Effective:

     

     

     

     

     

     

    05/08/2016

    2

    Five Year Review (FYR) Dates:

     

    05/08/2021

     

     

    CERTIFIED ELECTRONICALLY

     

     

     

    Certification

     

     

     

     

    04/28/2016

     

     

     

    Date

     

     

     

     

    Promulgated Under:

     

    119.03

     

     

    Statutory Authority:

    5164.02

     

     

    Rule Amplifies:

    5164.02

     

     

Document Information

Effective Date:
5/8/2016
File Date:
2016-04-28
Last Day in Effect:
2016-05-08
Rule File:
5160-8-41_PH_FF_N_RU_20160428_1059.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 5160-8-41. Medical nutrition therapy services