by Jared Staheli
July 6th, 2015
The following HCPCS codes are used to report DSMT:
• G0108 - Diabetes outpatient self-management training services, individual, per 30 minutes.
• G0109 - Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.
The type of service for these codes is 1.
Payment to physicians and providers for outpatient DSMT is made as follows:
|Type of Facility||Payment Method||Type of Bill|
|Physician (billed to the carrier)||MPFS||NA|
|Hospitals subject to OPPS||MPFS||12X, 13X|
|Method I and Method II Critical Access Hospitals (CAHs) (technical services)||101% of reasonable cost||12X and 85X|
|Indian Health Service (IHS) providers billing hospital outpatient Part B||OMB-approved outpatient per visit all inclusive rate (AIR)||13X|
|IHS providers billing inpatient Part B||All-inclusive inpatient ancillary per diem rate||12X|
|IHS CAHs billing outpatient Part B||101% of the allinclusive facility specific per visit rate||85X|
|IHS CAHs billing inpatient Part B||101% of the allinclusive facility specific per diem rate||12X|
|FQHCs*||All-inclusive encounter rate with other qualified services. Separate visit payment available with HCPCS.||73X|
|Skilled Nursing Facilities **||MPFS non-facility rate||22X, 23X|
|Maryland Hospitals under jurisdiction of the Health Services Cost Review Commission (HSCRC)||94% of provider submitted charges in accordance with the terms of the Maryland Waiver||12X, 13X|
|Home Health Agencies (can be billed only if the service is provided outside of the treatment plan)||MPFS non-facility rate||34X|
* Effective January 1, 2006, payment for DSMT provided in an FQHC that meets all of the requirements as above, may be made in addition to one other visit the beneficiary had during the same day, if this qualifying visit is billed on TOB 73X, with HCPCS G0108 or G0109, and revenue codes 0520, 0521, 0522, 0524, 0525, 0527, 0528, or 0900.
** The SNF consolidated billing provision allows separate part B payment for training services for beneficiaries that are in skilled Part A SNF stays, however, the SNF must submit these services on a 22 bill type. Training services provided by other provider types must be reimbursed by X the SNF.
NOTE: An ESRD facility is a reasonable site for this service, however, because it is required to provide dietician and nutritional services as part of the care covered in the composite rate, ESRD facilities are not allowed to bill for it separately and do not receive separate reimbursement. Likewise, an RHC is a reasonable site for this service, however it must be provided in an RHC with other qualifying services and paid at the all-inclusive encounter rate.
Deductible and co-insurance apply.