The American Diabetes Association has designated American Diabetes Month® as a time to communicate the seriousness of diabetes and the importance of proper diabetes control. Twenty four million adults and children in the United States suffer from diabetes. Complications from diabetes can include increased risk of heart disease, blindness, glaucoma, nerve damage, and kidney damage. However, detection and treatment of diabetes may prevent or delay many of these complications.
The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of diabetes screening tests for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes. Medicare also provides coverage for services to help beneficiaries effectively manage their diabetes. Coverage of these services is subject to certain eligibility and other limitations.
Diabetes Screening Tests
Medicare provides coverage of the following diabetes screening tests for eligible beneficiaries:
· A fasting blood glucose test, and
· A post-glucose challenge test; not limited to (an oral glucose tolerance test with a glucose challenge of 75 grams of glucose for non-pregnant adults), or
· A 2-hour post-glucose challenge test alone.
For beneficiaries diagnosed with diabetes, Medicare provides coverage of diabetes self-management training and medical nutrition therapy services to help beneficiaries learn to effectively manage their condition.
Diabetes Self-Management Training
Diabetes self-management training (DSMT) services are intended to educate beneficiaries in the successful self-management of diabetes. Medicare provides coverage of DSMT services for beneficiaries who have been recently diagnosed with diabetes, determined to be at risk for complications from diabetes, or were previously diagnosed with diabetes before meeting Medicare eligibility requirements and have since become eligible for coverage under the Medicare Program. Eligible Medicare beneficiaries must receive a referral from a physician or qualified non-physician practitioner certifying that DSMT services are needed to treat their diabetic condition.
Medical Nutrition Therapy
Medical nutrition therapy services (MNT) provided by a registered dietitian or a qualified nutrition professional may result in improved diabetes and renal disease management and other health outcomes and may help delay disease progression. Medicare provides coverage of MNT services for beneficiaries diagnosed with diabetes or renal disease (except for those receiving dialysis). Eligible beneficiaries must receive a referral from the treating physician, the primary care physician or specialist coordinating care for the beneficiary with diabetes or renal disease. Qualified non-physician practitioners cannot make referrals for MNT. NOTE: Medical nutrition therapy is a separate billable benefit from DSMT services. Eligible beneficiaries may receive referrals for both services but both services can not be received on the same day.
The Centers for Medicare and Medicaid Services (CMS) needs your help to ensure that people with Medicare are assessed for and informed about their risk factors for diabetes or pre-diabetes, and that those who are eligible take advantage of the diabetes screening tests. And, when appropriate provide referrals for DSMT and MNT. These services can help beneficiaries learn to manage their disease and may help lower the risk of serious complications.
For More Information
· For more information about Medicare’s coverage of diabetes screening services, diabetes self-management training, and medical nutrition therapy services, including coverage, coding, billing, and reimbursement guidelines, please visit the CMS Medicare Learning Network (MLN) Preventive Services Educational Products web page http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp