Diabetes Awareness

Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy

Table of Contents

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Diabetes Programs

  1. Are specific diagnosis codes required for both DSMT and MNT?

    Answer:     No, specific diagnosis codes are not required for DSMT and MNT services. However, a treating physician (PCP) must make a referral must indicate a diagnosis of diabetes or renal disease for services for these programs to be rendered. *A1c is not acceptable for supporting a diagnosis of diabetes.

    Effective 1/1/2022, MNT services may be referred by any physician. The service no longer requires a referral from a treating physician. Note: DSMT services require a referral from a physician or qualified NPP.
     
  2. Are there any conditions, other than diabetes or chronic kidney disease to be eligible for these programs?

    Answer:     The following conditions qualify for these programs:
  • Diabetes:
    • Diagnosed with Type 1, Type 2 or Gestational
    • Diabetes is a condition of abnormal glucose metabolism diagnosed using the following criteria:
      • FBS > 126 mg/dl on two different occasions
      • Two-hour post-glucose challenge > 200 mg/dl on two different occasions; or, a random glucose test over 200 mg/dl for a person with symptoms of uncontrolled diabetes
    • Renal:
    • Nondialysis kidney disease
    • Post-kidney transplants
  1. If the registered dietician is a certified diabetes educator, can they be the sole provider of DSMT services?

    Answer:     Yes, a registered dietitian or nutrition professional may be the sole provider of DSMT services if they are part of an accredited DSMT entity or represent an accredited DSMT entity and have an order from a physician or qualified NPP who’s treating the patient for diabetes. 
     
  2. How do you know if you qualify as a rural provider for the DSMT?

    Answer:     To determine if your area is a designated HPSA area, visit the Physician Bonuses web page on the CMS website, use the ZIP Code file in the download section.
     
  3. Can a provider have an RN do the education for DSMT?

    Answer:     Per CMS guidelines, an RN can provide services under direct supervision of a physician. Health professionals are medical professional such as, health educators, registered dietitians, nutrition professionals or other licensed practitioners, or a team of such medical professionals, working under the direct supervision (as defined in 42CFR 410.32(b)(3)(ii)) of a physician as defined in this section.
     
  4. For MNT services, must services be provided only to the individual or can it be in a group setting?

    Answer:     For MNT services there are no requirements for services, they can be provided either in an individual or group setting. *For DSMT, the provider must properly document why the beneficiary was not able to attend a group setting.
     
  5. If MNT services were ordered in December but not used until the next year, does the provider have to get a new order for the following year?

    Answer:     Yes. Hours for this program are based on the calendar year.
     
  6. What are the referral requirements for these programs?

    Answer:     Medical necessity for initial DSMT services must be established via a written or e-referral for DSMT by the treating provider. The treating provider (who must also be an active Medicare provider or in opt-out status) is the physician or qualified nonphysician practitioner (nurse practitioner, physician assistant, clinical nurse specialist) who is managing the beneficiary’s diabetes. However, for MNT services, any physician may make the referral. The physician must obtain a new referral every year.

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Billing for Services

  1. What CPT codes can I bill for DSMT and MNT?

    Answer:     Here are the CPT codes for billing DSMT and MNT services:
    • DSMT
    • G0108: Diabetes outpatient self-management training services, individual, per 30 minutes
    • G0109: Diabetes outpatient self-management training services, group session (two or more), per 30 minutes
      • Bill one unit per each 30-minute increment
         
    • MNT
    • 97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
    • 97803: Medical nutrition therapy; reassessment and intervention, individual, face-to-face with the patient, each 15 minutes
    • 97804: Medical nutrition therapy; group (two or more individual(s), each 30 minutes
  1. Can you bill an office visit and MNT services on the same day?

    Answer:     You can bill for an office visit and MNT visit on the same day. While a beneficiary can be enrolled in both MNT and DSMT, you cannot bill DSMT and MNT on the same date of service for the same beneficiary.
     
  2. Can the patient report their own blood glucose to meet the glucose level of >126 or must it be drawn by lab to qualify?

    Answer:     The patient cannot report their own glucose levels. Per CMS Program Guidelines, the only glucose billing codes are allowed are:
  • 82947 - Glucose, quantitative, blood (except reagent strip)
  • 82950 - post-glucose dose (includes glucose)
  • 82951 - tolerance test (GTT), three specimens (includes glucose)
  1. What are the co-payment requirements for DSMT and MNT?

    Answer: Patient Cost-Sharing:

  • DSMT: Co-insurance and Part B deductible applied.
  • MNT: Co-insurance and deductible waived.

DSMT and MNT Telehealth Services

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  1. Can you bill CPT 98970-98972 with these services?

    Answer:     No. Only the DSMT and MNT program CPT codes (listed above) can be billed for these services.

Related Content

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Reviewed 09/17/2024