Diabetes self-management training (DSMT) is an education program that can be provided to eligible newly diagnosed Medicare beneficiaries.Patients are eligible for 10 hours within the first year of diagnosis and then 2 hours each year thereafter. Education can be provided via group sessions (> 2 patients) or individually, though individual education must be justified.

 

CPT Codes

G0108, individual, per 30 minutes and G0109, group session, per 30 minutes

 

Criteria

• The physician must write an order for the patient stating the training is necessary
• Program material and site offering the education must be accredited by the ADA or AADE
• To be a part of an accredited program you must maintain a minimum of 15 hours of diabetes specific continuing education each year.
• Someone in the program must be a certified diabetes educator (CDE)
• Must bill incident to a recognized provider

 

Eligibility

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

• CMS covers 10 hours of training during your first year, if you are at risk of complications from diabetes or have just been diagnosed with the Disease
• Also covers two hours of training every year afterward as long as the trainings are conducted in groups of 2-20 people and the sessions last at least thirty minutes.
• Both insulin and non-insulin diabetics are eligible to have Medicare cover self-management training.

 

Opportunities for Consultant Pharmacists to Use the Codes

DSMT probably has the most difficult criteria to meet since the organization must be accredited by either the ADA or AADE.

However, overall gaining accreditation isn’t too difficult and if you are partnering with a provider who sees many diabetic patients helping them gain accreditation opens up an additional revenue stream.

Once accreditation has been established you can partner with the physician to provide DSMT.

Remember, DSMT must be ordered by the provider first.  Then the pharmacist can deliver the service.  It does not require a collaborative practice agreement unless you are making changes to the patients therapies.

Just as with the diabetes prevention programs, if monitoring patient data such as blood sugar, weight, or physical activity electronically you can also utilize the remote patient monitoring code.

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The next opportunity we’ll discuss is Medical Nutrition Therapy.

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