Diabetes Self-Management Training – Senior Plans

Medicare’s benefit coverage includes diabetes outpatient self-management training services (DSMT). Because HMSA’s senior plans follow Medicare guidelines, this benefit is extended to senior plan members. Coverage will only apply when these services are furnished by a provider recognized and approved by HMSA. Restrictions on the frequency of screenings are determined by the service date of the procedure.

Guidelines for Coverage

• The training must be ordered by the physician or qualified non-physician practitioner treating the beneficiary’s diabetes.
• The program providing the DSMT must be certified by the American Diabetes Association or the American Association of Diabetes Educators (AADE).
• A beneficiary is eligible to receive 10 hours of initial training within a continuous 12-month period. The 12-month period does not need to be on a calendar-year basis.
• Up to nine hours of initial training may be provided in a group setting consisting of two to 20 individuals.
• One hour of training may be provided on an individual basis for the purpose of conducting an individual assessment and providing specialized training.

If any special condition or circumstance exists that makes it impossible for a beneficiary to attend a group training session, the beneficiary may attend individual training as long as individual training has been requested by the physician or qualified non-physician practitioner treating the beneficiary’s diabetes.

Medicare also covers two hours of follow-up training each year, starting with the calendar year following the year in which the beneficiary completes the initial 10 hours of training. The two hours of training may be given in any combination of half-hour increments within each calendar year on either an individual or group basis, without the need for certification by the ordering physician or non-physician practitioner that special conditions exist.

Codes

The following codes may be used to describe diabetes outpatient self-management training:

Medicare also covers blood glucose monitors and testing strips for individuals with type II diabetes.

Diabetes Care

For more information, please visit the Diabetes Education information page.

Revision History