Special Processing Instructions for Billing Frequency Requirements of DSMT Services (Rev. 1255, 07-02-07)

by  Jared Staheli
July 6th, 2015

The frequency editing for DSMT is performed in CWF as follows:

A - Initial Training

The initial year for DSMT is the '12' month period following the initial date. When a claim contains a DSMT HCPCS code and the associated units cause the total time for the DSMT initial year to exceed '10' hours, a CWF error will set.

See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, section 300 for information on coverage for initial training.

B - Follow-Up Training

Follow-up training for subsequent years are based on a 12 month calendar year after the initial year. However, if the beneficiary exhausts 10 hours in the initial year then the beneficiary would be eligible for follow-up training in the next calendar year. When a claim contains a DSMT HCPCS code and the associated units cause the total time for any follow-up year to exceed 2 hours, a CWF error will set.

See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, section 300 for information on coverage for follow-up training.

C - Examples

Example # 1 -- Beneficiary Exhausts 10 hours in the Initial Year (12 continuous months)

Bene receives first service: April, 2006

Bene completes initial 10 hours DSMT training: April, 2007

Bene is eligible for follow-up training: May 2007 (13th month begins the subsequent year)

Bene completes follow-up training: December, 2007

Bene is eligible for next year follow-up training: January, 2008

Example # 2 Beneficiary Exhausts 10 hours Within the Initial Calendar Year

Bene receives first service: April 2006

Bene completes initial 10 hours of DSMT training, December 2006

Bene is eligible for follow-up training: January, 2007

Bene completes follow-up training: July 2007

Bene is eligible for next year follow-up training: January 2008

References:

Special Processing Instructions for Billing Frequency Requirements of DSMT Services (Rev. 1255, 07-02-07). (2015, July 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/special-processing-instructions-for-billing-frequency-requirements-of-dsmt-services-rev-1255-07-02-07-27032.html

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