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Diabetic, Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT) Services

Medicare provides coverage of diabetes screening tests for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes.

Access the below related information from this page.

DSMT

Coverage is provided for beneficiaries who have been recently diagnosed with diabetes, were determined to be at risk for complications from diabetes, or were previously diagnosed with diabetes before meeting Medicare eligibility requirements and have since become eligible for coverage under the Medicare Program when a certified provider who meets certain quality standards furnishes these services.

HCPCS/CPT Codes

  • G0108 – DSMT, individual, per 30 minutes
  • G0109 – DSMT, group (2 or more), per 30 minutes

ICD-9-CM Codes

  • No specific diagnosis code
  • Contact local Medicare Administrative Contractor (MAC) for guidance

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 initial year

Beneficiary Pays

  • Copayment/coinsurance applies
  • Deductible applies

MNT

Coverage is provided for beneficiaries diagnosed with diabetes and/or renal disease (except for those receiving dialysis) and post renal transplant when provided by a registered dietitian or nutrition professional who meets provider qualifications requirement. Three hours of MNT is covered in first year and two hours in subsequent years, and additional hours in certain situations.

Resources

Last Updated Jul 28, 2017

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.