Medicare Part B (Medical Insurance) covers outpatient diabetes self-management training (DSMT) to teach you to cope with and manage your diabetes. It includes tips for eating healthy, being active, monitoring blood sugar, taking drugs, and reducing risks. Medicare may cover up to 10 hours of initial DSMT. This training may include 1 hour of individual training and 9 hours of group training. You may also qualify for up to 2 hours of follow-up training each year if it takes place in a calendar year after the year you got your initial training.

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

HCPCS/CPT Codes

G0108 - DSMT, individual, per 30 minutes

G0109 - DSMT, group (2 or more), per 30 minutes

ICD-10-CM Codes

See the CMS ICD-10 webpage for individual Change Requests (CRs) and coding translations for ICD-10 and contact your Medicare Administrative Contractor (MAC) for guidance.

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

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

   • Copayment applies

   • Coinsurance applies

   • Deductible applies

References