Certified Diabetes Educators and Diabetes Self Management Training (DSMT): How do they bill for this?
DSMT is billed using HCPCS code G0108 and G0109. DSMT can be furnished by anyone who qualifies for direct payment for services done by Medicare and meets the definition of certified provider as stated in CMS Publication 100-2, the Medicare Benefit Policy Manual, Chapter 15, section 300.2. The services of a certified diabetes educator (CDE) could be billed as part of an accredited DSMT program or if he/she is eligible for direct payment from Medicare (for example, a nurse practitioner who is also a certified diabetes instructor). A CDE that is not able to directly bill Medicare could not do DSMT as an “incident to” service to a physician billed either as DSMT or as an E&M visit (i.e. either service billed under the physician’s number). If ancillary staff provides Diabetes training in the course of an office visit, it is considered bundled into a medically necessary E&M visit provided by the billing physician that same date. If the only reason for the encounter was Diabetes training by t
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