As of January,
1999, the Balanced Budget Act of 1997 covers training for diabetes
outpatient self management. To bill for those services, however, you
need to meet the National Diabetes Advisory Board (NDAB) requirements.
outpatient self- management and training service is a program that must
include the following three components:
about self- monitoring of blood glucose, diet and exercise
treatment plan developed specifically for the patient who is
patients to use the skills for self-management.
To ensure therapy
compliance you'll need physician certification that such services are
needed under a comprehensive plan of care related to the patient's
Centers for Medicare and Medicaid Services (CMS, formerly HCFA) is
designating as a "certified provider" those physicians,
individuals, (such as non-physician practitioners) or entities that are
paid under the physician fee schedule. These certified providers must
meet the NDAB standards. The American Diabetes Association also must
recognize certified providers.
To bill, use the
Diabetes outpatient self-management training services, individual
session, per 60 minutes of training.
Diabetes outpatient self-management training services, group
session, per individual, per 60 minutes of training.
On the first claim
for this service, you must include a "Certificate of
Recognition" from the American Diabetes Association that affirms
you're a recognized provider. Bill the appropriate E&M code for the
initial office visit.
For 1998, Centers for Medicare and Medicaid Services (CMS, formerly HCFA)
allows $55.41 per hour for an individual sessions and $32.62 per
patient per hour in a group session.
Standards for Diabetes Self-Management Education Programs and American
Diabetes Association Review Criteria