Diabetes Outpatient Self Management Training Service
Diabetes self-management training (DSMT) 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 (ADA) or accredited and approved by the Centers for Medicare and Medicaid Services (CMS) 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 and
- 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.
This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.
Last Updated 7/12/2022