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Frequently Asked Questions for Diabetes Self-Management Training and Medical Nutrition Therapy

  • Diabetes Programs
  • Billing for Services
  • DSMT and MNT Telehealth Services
  • Related Content
  • Diabetes Programs

    1. Are specific diagnosis codes required for both DSMT and MNT?

      Answer:
      No, specific diagnosis codes are not required for DSMT and MNT services. However, a treating physician (PCP) must make a referral and indicate a diagnosis of diabetes or renal disease for services for these programs to be rendered. *A1c is not acceptable for supporting a diagnosis of diabetes.

    2. Are there any conditions, other than diabetes or chronic kidney disease to be eligible for these programs?

      Answer:
      The following conditions qualify for these programs:
      • Diabetes:
        • Diagnosed with Type 1, Type 2 or Gestational
        • Diabetes is a condition of abnormal glucose metabolism diagnosed using the following criteria:
          • FBS > 126 mg/dl on two different occasions
          • Two-hour post-glucose challenge > 200 mg/dl on two different occasions; or, a random glucose test over 200 mg/dl for a person with symptoms of uncontrolled diabetes
      • Renal:
      • Non-dialysis kidney disease
      • Post-kidney transplants
    1. If the registered dietician is a certified diabetes educator, can they be the sole provider of DSMT/MNT services?

      Answer:
      No, a dietitian may not be the sole provider of DSMT/MNT services; however there is an exception for rural locations.

    2. How do you know if you qualify as a rural provider for the DSMT?

      Answer:
      To determine if your area is a designated HPSA area, visit the Physician Bonuses web page on the CMS website, use the ZIP Code file in the download section.

    3. Can a provider have an RN do the education for DSMT?

      Answer:
      Per CMS guidelines, an RN can provide services under direct supervision of a physician. Health professionals are medical professional such as, health educators, registered dietitians, nutrition professionals or other licensed practitioners, or a team of such medical professionals, working under the direct supervision (as defined in 42CFR 410.32(b)(3)(ii)) of a physician as defined in this section.

    4. For MNT services, must services be provided only to the individual or can it be in a group setting?

      Answer:
      For MNT services there are no requirements for services, they can be provided either in an individual or group setting. *For DSMT, the provider must properly document why the beneficiary was not able to attend a group setting.

    5. Do DSMT coverage limits follow the same guidelines that MNT follows? Do the subsequent hours start over with a new year?

      Answer:
      Yes. DSMT and MNT program hours follow the same guidelines and hours start every calendar year.

    6.  If MNT services were ordered in December but not used until the next year, does the provider have to get a new order for the following year?

      Answer:
      Yes. Hours for this program are based on the calendar year.

    7. What are the referral requirements for these programs?

      Answer:
      A treating physician (PCP) must make a referral for services for these programs to be rendered. The beneficiary must obtain a new referral every year.

    Billing for Services

    1. What CPT codes can I bill for DSMT and MNT?

      Answer:
      Here are the CPT codes for billing DSMT and MNT services:
      • DSMT
        • G0108: Diabetes outpatient self-management training services, individual, per 30 minutes
        • G0109: Diabetes outpatient self-management training services, group session (two or more), per 30 minutes
        • Bill one unit per each 30-minute increment
      • MNT
        • 97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
        • 97803: Medical nutrition therapy; reassessment and intervention, individual, face-to-face with the patient, each 15 minutes
        • 97804: Medical nutrition therapy; group (two or more individual(s), each 30 minutes
    1. Are there modifiers for these services?

      Answer:
      Yes. During the Public Health Emergency, modifier 95 should be used when a real-time interaction between the provider at the distant site and the patient at an originating site occurs via an audio or an audio and video telecommunications system. It should be appended to all DSMT/MNT services.

    2. Can you bill an office visit and MNT services on the same day?

      Answer:
      You can bill for an office visit and MNT visit on the same day. While a beneficiary can be enrolled in both MNT and DSMT, you cannot bill DSMT and MNT on the same date of service for the same beneficiary.

    3. Can the patient report their own blood glucose to meet the glucose level of >126 or must it be drawn by lab to qualify?

      Answer:
      The patient cannot report their own glucose levels. Per CMS Program Guidelines, the only glucose billing codes are allowed are:
        • 82947 - Glucose, quantitative, blood (except reagent strip)
        • 82950 - post-glucose dose (includes glucose)
        • 82951 - tolerance test (GTT), three specimens (includes glucose)

    MLN Matters® SE0821 Revised: Reminder – Medicare Provides Coverage of Diabetes Screening Tests offers more information.

    1. What are the co-payment requirements for DSMT and MNT?

      Answer
      : Patient Cost-Sharing:
        • DSMT: Co-insurance and Part B deductible applied.
        • MNT: Co-insurance and deductible waived.

    DSMT and MNT Telehealth Services

    1. Can we provide DSMT and MNT services via Telehealth?

      Answer:
      Yes. During the current Public Health Emergency:
      • DSMT services can be provided via telehealth. This includes audio-only.
      • MNT services can be provided via telehealth. This includes audio-only.

    2. Can DSMT and MNT count for hours if billed via telehealth?

      Answer:
      All DSMT and MNT services can be billed via telehealth and will count towards program hours. During the current Public Health Emergency (COVID-19) services can also be rendered via audio-only communication.
    3. Can you bill CPT 98970-98972 with these services?

      Answer:
      No. Only the DSMT and MNT program CPT codes (listed above) can be billed for these services.

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    Frequently Asked Questions for Diabetes Self-Management Training and Medical Nutrition Therapy
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