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Dietitian Invoice Template

MNT codes, units, group sessions and referral details. Free PDF, no account.

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Medical nutrition therapy is billed in units, and the units are not all the same length — individual sessions count in fifteen-minute increments while group sessions count in thirty. Mixing them, or billing a returning patient as a new assessment, is what turns a straightforward claim into a denial months later.

INVOICE Issued
Invoice number:INV-0001
Date of issue:September 19, 2026
Date due:October 3, 2026
Currency:USD
Issued by
Alder & Fern Nutrition
9 Harvest Lane
Suite 5
05401 Burlington, VT
United States
billing@alderfernnutrition.example
Bill to
Silvia Marchetti
410 Winooski Avenue
05403 Burlington, VT
United States
s.marchetti@example.com
Amount due
$888.00
Due in 14 days · Oct 3, 2026
For your claim
Registered Dietitian, NPI 1583927461, Vermont registration RD-11284, tax ID 03-4471928. Referred by Dr. K. Osei for diagnosis E11.9. Individual codes are 15-minute units and the group code is 30-minute units. Place of service 11, except the two telehealth sessions at 10.
Description Qty Rate Tax Amount
97802 — MNT initial assessment
Individual, face to face, 15-minute units
4$38.00—$152.00
97803 — MNT reassessment and intervention
Four follow-up sessions, 15-minute units
12$36.00—$432.00
97803 — MNT follow-up, telehealth
Two sessions by video, 15-minute units
6$36.00—$216.00
97804 — Group medical nutrition therapy
Two group sessions, 30-minute units
4$22.00—$88.00
Subtotal$888.00
Total$888.00
Amount due $888.00
Terms
Payable on receipt. Submit to your plan under your nutrition benefit; a referral is on file.
Invoice #INV-0001 · Alder & Fern Nutrition Page 1 of 1

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What to put on a dietitian invoice

  • Your NPI, registration and the practice tax ID
  • The initial assessment separately from follow-up sessions, since they are different codes
  • Units against each session, with the length a unit represents
  • Group sessions apart from individual ones — they are counted in half-hour units
  • The referral and diagnosis, where the plan requires one
  • Telehealth sessions marked, with the place-of-service code

Questions

When do I bill an initial assessment again?

Rarely. A patient returning after their first visit is a follow-up regardless of how long it has been — the usual exception is a patient discharged and then re-referred more than a year later. Re-billing the initial code because a gap felt long is a common and avoidable denial.

Are group sessions billed the same way?

No. Group medical nutrition therapy is counted in thirty-minute units rather than fifteen, so a ninety-minute group is three units and not six. It is the arithmetic most often got wrong on a nutrition claim.

Are there daily unit limits?

Medicare applies them, and commercial plans usually follow — commonly eight units a day for individual therapy and six for group. Bill against the limit rather than against the clock, and check it before a long session rather than after.

About the free invoice generator

Is this invoice generator really free?

Yes. There is no fee, no trial period and no watermark on the PDF. Nothing on this page requires a credit card.

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What file do I get?

A standard PDF, ready to attach to an email or print.

Can I add my own logo and bank details?

Yes. The seller section accepts a logo image and bank transfer details, which are printed on the invoice so your client knows how to pay you.

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Can I use this for any currency or country?

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