Billing codes · HCPCS code
G0270 and G0271: extra Medicare MNT hours after a second referral
By Javier Alvarez · Updated · 4 min read
| G0270 | MNT reassessment and subsequent intervention(s), individual, face-to-face, each 15 minutes |
|---|---|
| G0271 | Same, group (2 or more), each 30 minutes |
| Trigger | Second referral in the same year for a change in diagnosis, condition or treatment |
| Who refers | A physician (MD or DO) |
| Medicare MUE | G0270: 8 units/day; G0271: 4 units/day (table effective Oct 1, 2026) |
| 2026 PFS | Status A; same RVUs as 97803 (G0270) and 97804 (G0271) |
| Telehealth (2026 list) | G0270 yes; G0271 no |
| Review | Medical review of extra hours happens after payment |
Say a patient with diabetes has used her 2 Medicare MNT hours by June. In August her nephrologist diagnoses stage 3 kidney disease, and her diet needs to change again. Can you keep seeing her under Medicare? Yes, if the physician sends a second referral, and the extra visits go on the claim as G0270, not 97803.
G0270 and G0271 are HCPCS Level II codes created by CMS for this one situation.
What G0270 and G0271 cover
The HCPCS descriptors, as CMS prints them in its claims manual:
- 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.
- G0271: the same, for a group (2 or more individuals), each 30 minutes.
In plain terms: these are 97803 and 97804 for time beyond the standard annual hours, unlocked by a second referral that documents a change. In the 2026 Physician Fee Schedule file, G0270 carries the same relative value units as 97803 and G0271 the same as 97804, so the code signals why the hours are allowed. It doesn't change the payment rate.
When Medicare allows hours beyond 3 and 2
Standard Medicare MNT is 3 hours in the first calendar year and 2 hours in each year after (NCD 180.1). The regulation carves out one exception: more hours when a physician determines there's a change of diagnosis, medical condition or treatment regimen related to diabetes or renal disease that requires a change in MNT during an episode of care (42 CFR 410.132(b)(5)).
Changes a physician might document (examples, not an official list):
- A patient with diabetes is newly diagnosed with chronic kidney disease
- Kidney disease progresses to a stage that changes protein, potassium or phosphorus targets
- A treatment change, such as starting insulin, that changes the meal plan
- A kidney transplant (Medicare's renal MNT benefit covers the 36 months after one)
CMS doesn't publish a maximum number of extra hours. The claims manual says medical review for this provision happens post-payment, and outliers "may be judged against nationally accepted dietary or nutritional protocols." Bill the hours the new plan of care needs, and make sure the note shows why.
Referral requirements
The second referral is what makes G0270 payable:
- From a physician. For Medicare MNT, only an MD or DO can refer (42 CFR 410.132(c)).
- Names the change. The referral and the physician's record should document the new diagnosis, condition or treatment.
- Same year. It's a second referral in the calendar year, on top of the one that covered the standard hours.
- NPI on the claim. The referring physician's NPI goes on every MNT claim; Medicare returns claims without it (§300.2).
Keep the referral in the chart. Physician referrals for dietitians covers how to ask for one without a week of phone tag.
G0270 vs 97803: the decision
| Question | Answer | Code |
|---|---|---|
| Individual follow-up within this year's standard hours? | Yes | 97803 |
| Individual visit beyond the standard hours, with a second referral for a change? | Yes | G0270 |
| Group visit within the standard hours? | Yes | 97804 |
| Group visit beyond the standard hours, with a second referral? | Yes | G0271 |
| Beyond the standard hours, no second referral? | Not covered | Issue an ABN first, or don't bill Medicare |
One detail from the manual: 97803 is also used when a change in condition is addressed within the standard hours. G0270 is specifically for hours beyond them.
On the ABN: CMS says the beneficiary is liable for services denied over the limited number of hours, and an Advance Beneficiary Notice should be issued. Without a valid ABN, the provider is liable (§300.6).
Units and documentation
| Code | Unit | Units from the midpoint rule | Medicare MUE (Oct 1, 2026) |
|---|---|---|---|
| G0270 | 15 minutes | 8–22 min = 1, 23–37 = 2, 38–52 = 3, 53–67 = 4 | 8 per day |
| G0271 | 30 minutes, per participant | 16–45 min = 1, 46–75 = 2 | 4 per day |
Each G0270/G0271 note should show:
- The new referral (date, physician) and the change it documents
- A reassessment tied to that change: new labs, new targets, new medication
- The revised intervention and goals
- Face-to-face time, so the units are defensible
- The diagnosis that reflects the change (for example, N18.x added to E11.x)
Telehealth
G0270 is on the CY 2026 Medicare telehealth list, and home telehealth is allowed through December 31, 2027. G0271 isn't on the 2026 list. A group reassessment after a second referral should be in person unless CMS adds the code. Use POS 10 or 02 on telehealth G0270 claims, as for other MNT codes.
Denials to expect, and the fix
- Benefit maximum reached (CO-119) on a 97803 line: the year's hours are used up. If there's a documented change, get the second referral and bill the extra time as G0270.
- G0270 without a second referral on file: it can pay at first and still fail post-payment review. Don't bill G0270 as a way around the hours cap.
- Missing referring NPI: the claim comes back unprocessable. Add the NPI and resubmit.
- G0271 via telehealth: not on the 2026 list. Review before you bill.
For the whole Medicare picture, start with the Medicare MNT billing guide.