Medicare Payment Rate Advocacy

Why the Medicare Payment Rate Matters

With health care costs on the rise and America's population aging, policymakers have pursued efforts to maintain solvency for the Medicare Trust Fund without increasing payroll taxes. For providers, these policies have resulted in an increasingly unstable payment system and declining payment rates relative to inflation. Compounding this issue are large, annually proposed cuts to Medicare payment rates.

Each year, the Centers for Medicare & Medicaid Services (CMS) issues the Physician Fee Schedule (PFS) final rule, which updates payment rates and policies for services provided by physicians and other health care professionals. The PFS establishes the payment rates used across Medicare. By law, registered dietitians are reimbursed at 85% of the physician fee, with rates varying by geographic locality.

Medicare Part B covers medical nutrition therapy (MNT) services provided by qualified registered dietitians or nutrition professionals for certain beneficiaries. This includes individuals with diabetes or non-dialysis kidney disease, as well as those who have received a kidney transplant within the past 36 months. Due to the Affordable Care Act's preventive services designation, these services are available to eligible beneficiaries with no out-of-pocket costs.

A physician (MD/DO) referral is required to access MNT services. Beneficiaries are eligible for three hours of MNT in the initial year and two hours in each subsequent year, with additional hours available if medically necessary and ordered by a physician.

The Academy's Stance on Medicare Payment Rate

The Academy advocates for preventing cuts and improving Medicare Part B payment rates for registered dietitian nutritionists (RDNs). This includes direct advocacy with policymakers, participation in coalitions, and efforts to elevate the voices and experiences of RDNs in the policy process.

Medicare payment is also shaped by medical coding, which is overseen by the American Medical Association (AMA) and designed to reflect how services are delivered in clinical practice. Because these coding decisions directly influence how services are valued and reimbursed, the Academy actively engages in this process as part of its broader advocacy to ensure appropriate recognition and payment for RDN services.

Get Involved

Understanding how Medicare payment rates are determined and what laws and regulations underlie these rates is crucial to being an informed advocate for the profession. The MNT and Payment Affinity Group meets quarterly to discuss Academy advocacy priorities and strategies related to enhancing access to MNT and nutrition care services. Join the MNT and Payment Affinity Group.

Medicare Payment Rate Advocacy Resources

• Medicare Part B: History of Payment Rates, Payment Cuts, and Academy Advocacy, an article published in the October 2023 issue of the Journal of the Academy of Nutrition and Dietetics