Diabetes Self-Management Training (DSMT) (NCD 40.1)
Diabetes is a medical condition in which your body doesn’t make enough
insulin, or has a reduced response to insulin. Diabetes causes your blood sugar
to be too high because insulin is needed to use sugar properly. A high blood
sugar level isn’t good for your health. Medicare covers a blood screening test to
check for diabetes for people at risk.
HCPCS/CPT Codes
G0108 – Diabetes outpatient self-management training services, individual, per 30 minutes
G0109 – Diabetes outpatient self-management training services, group (2 or more), per 30 minutes
ICD-10-CM (ICD-9-CM) Codes
No specific diagnosis code
Contact local Medicare Administrative Contractor (MAC) for guidance
Who Is Covered
Certain Medicare beneficiaries who:
Are diagnosed with diabetes; and
Who receive an order for DSMT from the physician or qualified non-physician practitioner (NPP) treating the beneficiary’s diabetes
Frequency
Initial year: Up to 10 hours of initial training within a continuous 12-month period; or
Subsequent years: Up to 2 hours of follow-up training each year after the initial year