Diabetes Outpatient Self Management Training Service

Diabetes self-management training is a limited benefit. This outpatient program educates beneficiaries on the self-management of diabetes. The DSMT program must be TRICARE-authorized and accredited by the American Diabetes Association or accredited and approved by the Centers for Medicare and Medicaid Services  to provide DSMT services. (Only HCPCS codes G0108 and G0109 are covered.)

Outpatient services in this program include:

• Education for self-monitoring blood glucose, diet, and exercise
• Insulin treatment plans for insulin-dependent beneficiaries
• A plan to motivate patients to use the skills for self-management

The following medical conditions, as well as any other medical condition in which diabetes self-management training is medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition., would be eligible for coverage for training services.

• New onset diabetes
• Poor glycemic control in the 90 days before attending the training
• A change in the treatment regimen from no diabetes medications to any diabetes medication, or from oral diabetes medication to insulin.
• High risk for complications based on poor glycemic control; documented episodes of severe hypoglycemia or acute severe hypoglycemia occurring in the past year during which the beneficiary needed third party assistance for either emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. visits or hospitalization

Initial Training (First Year)

DSMT must be ordered by a physician for beneficiaries with diabetes. Services are limited to 10 hours. Additional hours may be covered if the treating physician determines there is a change in medical condition, diagnosis, or treatment that requires a change in DSMT.

Follow-Up Training (Subsequent Years)

Beneficiaries are eligible to receive two hours of follow-up training each calendar year. Training may include a change in DSMT due to a change in medical condition, diagnosis, or treatment as determined by the treating physician.