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Questions have been raised by providers of Diabetes Outpatient Self-Management Training (DSMT) services as to whether
supervision and other "incident to" requirements must be met when billing for DSMT services. The "incident to" supervision
rules and other "incident to" requirements published in Medicare Part B Newsletter No. 03-031, dated Nov. 29, 2002, do not
apply to DSMT services. Medicare authorizes DSMT in a stand-alone provision.
Brief Overview of the Diabetes Outpatient Self-Management Training Services
22 DSMT services are covered only if the physician or qualifi ed non-physician practitioner who is managing the
benefi ciary's diabetic condition certifi es that such services are needed and refers the patient to the DSMT program. The
referral must be done under a comprehensive plan of care related to the benefi ciary's diabetic condition.
22 Who May Furnish DSMT Services - Training may be furnished by a physician, individual or entity that meets the
following conditions:
- Furnishes other services for which direct Medicare payment may be made.
- May properly receive Medicare payment.
- Submits necessary documentation to, and is accredited by, an accreditation organization approved by the Centers
for Medicare & Medicaid Services (CMS) previously described in Medicare Part B Newsletter No. 01-020, pgs. 31-
32, dated Sept. 1, 2001.
22 Who May Bill For This Service - Any certifi ed providers or suppliers that provide other individual items or
services under Medicare that meet CMS' quality standards and meet the conditions for CMS approval may receive
reimbursement for diabetes training. Entities are more likely than individuals to bill for DSMT services. These certifi ed
providers must be currently receiving payment for other Medicare services.
supervision and other "incident to" requirements must be met when billing for DSMT services. The "incident to" supervision
rules and other "incident to" requirements published in Medicare Part B Newsletter No. 03-031, dated Nov. 29, 2002, do not
apply to DSMT services. Medicare authorizes DSMT in a stand-alone provision.
Brief Overview of the Diabetes Outpatient Self-Management Training Services
22 DSMT services are covered only if the physician or qualifi ed non-physician practitioner who is managing the
benefi ciary's diabetic condition certifi es that such services are needed and refers the patient to the DSMT program. The
referral must be done under a comprehensive plan of care related to the benefi ciary's diabetic condition.
22 Who May Furnish DSMT Services - Training may be furnished by a physician, individual or entity that meets the
following conditions:
- Furnishes other services for which direct Medicare payment may be made.
- May properly receive Medicare payment.
- Submits necessary documentation to, and is accredited by, an accreditation organization approved by the Centers
for Medicare & Medicaid Services (CMS) previously described in Medicare Part B Newsletter No. 01-020, pgs. 31-
32, dated Sept. 1, 2001.
22 Who May Bill For This Service - Any certifi ed providers or suppliers that provide other individual items or
services under Medicare that meet CMS' quality standards and meet the conditions for CMS approval may receive
reimbursement for diabetes training. Entities are more likely than individuals to bill for DSMT services. These certifi ed
providers must be currently receiving payment for other Medicare services.
