Expanded Coverage of Diabetes Outpatient Self-Management Training

Original Effective Date: 10/01/2001
Revision Effective Date: 11/01/2013

Diabetes Outpatient Self-Management Training is now a covered Medicare service for a wider variety of Medicare providers/suppliers. Local carriers, not DMERCs, have claims processing jurisdiction for these services. To qualify for payment under this benefit, the supplier of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must first be enrolled in the Medicare program and currently eligible to receive reimbursement for Medicare covered services. All suppliers must meet the American Diabetes Association's (the successor to the National Diabetes Advisory Board) National Standards for Diabetes Self-Management Education Programs that were published in Diabetes Care, Volume 23, Number 5.

If you are a DMEPOS supplier that wants to receive Medicare reimbursement for diabetes education and meet the above qualification, you should contact the local Medicare carrier who services your area. See http://www.hcfa.gov/Medicare/incardir.htm to determine the local carrier for your area.

 The carrier will require you to submit a completed Form HCFA-855, along with your ADA recognition certificate. After it has been determined that you meet the quality standards, you will be sent your billing number. Once you have received your billing (PIN) number, you can begin receiving reimbursement for this service. All providers and suppliers including DMEPOS suppliers are eligible to receive retroactive payment for this service back to the later of February 27, 2001, or the date of recognition by the ADA. Specific coverage and payment criteria apply. DMEPOS suppliers should become familiar with the details of this covered Medicare service by reviewing HCFA-Pub. 60B, Transmittal B-01-40 on the HCFA Web site at www.hcfa.gov/pubforms/transmit/memos/comm_date_dsc.htm.


            Last Updated Wed, 01 Aug 2018 12:30:31 +0000