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POLICYDiabetes self-management training (DSMT) services are covered when these services are provided by a Certified Diabetes Educator (CDE), a Registered Dietician (RD), a Medical Doctor (MD), a clinic, or an outpatient hospital. The DSMT is done to teach the diabetic patient how to control and monitor blood glucose levels with the proper use of the monitoring device, dietary calculations and restrictions, and correct administration of diabetic medications.
Indications and Limitations of Coverage
Diabetes self-management training services (DSMT) and medical nutrition therapy (MNT) are covered for a combined total of 6 hours per calendar year for a member who has been diagnosed with diabetes.
Members are eligible to receive 1 hour of medical nutrition therapy (MNT) per calendar year: 30 minutes of initial assessment and 30 minutes of follow-up or re-assessment. The following codes below are used to report these services.
Members are also eligible to receive 5 additional hours of diabetes self-management training (DSMT) education per calendar year. Any codes listed below or combination of the codes may be filed for the remaining 5 hours allowed.
If the 6 hours are exceeded during the calendar year, the claim will be denied as benefits exhausted.
POLICY EXCEPTIONSSTATE and FEP
POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY04/29/2011-Policy Drafted
10/10/2011-1 hour of medical nutrition therapy (MNT)' was corrected to read "2 hours of medical nutrition therapy (MNT)' instead.
07/20/2012-Removed 10 units and 2 hour verbiage for policy clarification.