Program_Memos / 2000 / AB-00-66

Why This Topic Matters

It clarifies how a covered diabetes education benefit was implemented in Medicare and how claims for the service were to be reported and paid. That makes it relevant to providers, billing departments, and coders handling outpatient diabetes education claims.

Article Sections

1. Change Request 199

   Introductory material identifying the memorandum, its reissue status, and the effective date for the subject change request.

2. The Balanced Budget Act of 1997

   Background on the statutory basis for the coverage change and the general purpose of the benefit.

3. Certified Providers

   Overview of the provider categories and qualifications associated with furnishing the service under Medicare.

4. The Rules for Billing and Payment to Non-Physician Practitioners Providing Diabetes Outpatient Self-Management and Training

   Administrative discussion of how certain nonphysician practitioners fit into billing and payment arrangements for the service.

5. Coding and Payment

   Claims reporting and payment guidance for the diabetes self-management training benefit, including the HCPCS procedure identifiers used for billing.

6. Sandards

   A long set of organizational, process, and outcome standards tied to recognition and program qualification.

7. Carrier Billing Requirements

   Instructions for carrier claims processing, claim forms, documentation, and patient cost-sharing treatment.

8. Billing Requirements for Intermediaries

   Instructions for intermediary claims processing, revenue code reporting, claim form fields, and supporting documentation.

9. Applicable Bill Types

   A listing of the bill type categories referenced for the service when billed under applicable Medicare settings.

10. Medicare Summary Notice (MSN) and Explanation of Your Medicare Benefits (EOMB) Messages

    Standard notice language guidance for denied claims and related beneficiary messaging.