Preventive Services: Diabetes Self-Management Training (DSMT)

by  Find-A-Code™
Sep 1st, 2017

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Diabetes Self-Management Training: 

HCPCS/CPT Codes

ICD-10 Codes

See the CMS ICD-10 webpage for individual CRs and coding translations for ICD-10, and contact your MAC for guidance.

Who Is Covered

Certain Medicare beneficiaries when all of the following are true:

• Diagnosed with diabetes
• Receive an order for DSMT from the physician or qualified NPP treating the Medicare beneficiary's diabetes

Frequency

• Initial year: Up to 10 hours of initial training within a continuous 12-month period
• Subsequent years: Up to 2 hours of follow-up training each year after the initial year

Medicare Beneficiary Pays

• Copayment/coinsurance applies
• Deductible applies

Other Notes

• Refer to Provider Compliance Tips for Diabetic Test Strips for more information.

Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.