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Diabetes Self-Management, Supplies, and Other Medical Services--Provider Resources This page provides information and resources for providers on Medicare coverage for diabetes self-management training services and supplies, including therapeutic shoes, blood glucose testing supplies, and insulin pumps. Providers may bill the Medicare contractor they routinely bill for Part B services for diabetes self management training services and other medical services that are important for people with diabetes to receive. However, claims for diabetes supplies are processed by four contractors, known as Durable Medical Equipment Regional Contractors or DMERCs. Diabetes Self Management Training Services Medicare provides coverage for diabetes self management training services for the following people: - Beneficiaries who have recently been diagnosed with diabetes;
- Beneficiaries with diabetes who are at risk for complications from the disease;
- Beneficiaries who were previously diagnosed with diabetes before being eligible for Medicare and who have become eligible for Medicare
The Medicare Part B deductible and copayment or coinsurance applies to this benefit. Medicare provides coverage for diabetes self management training services only if the physician managing the diabetic beneficiary's condition certifies that such services are needed under a comprehensive plan of care. The contents of the plan of care are described in the Medlearn Matters link below. To be covered by Medicare, diabetes self management training services must be accredited as a diabetes self management training program by the American Diabetes Association (ADA) or Indian Health Service (IHS), must provide services to eligible Medicare beneficiaries, and must submit an accreditation certificate from the ADA, IHS, or another CMS-recognized program to the local Medicare contractor's provider enrollment department. In addition to initial diabetes self management training services, Medicare may cover follow-up training in certain circumstances. See the Medlearn Matters link below for more information on this benefit. Diabetes Supplies Medicare covers blood glucose testing equipment and supplies for insulin-dependent and non-insulin dependent diabetic beneficiaries. The Medicare deductible and copayment or coinsurance applies. The Medicare provider must provide the beneficiary with a prescription that in addition to saying the beneficiary has diabetes, includes the number of test strips and lancets required for one month, the type of meter required, whether a person requires insulin or not, and how often the person should test his or her blood sugar level. Medicare covers therapeutic shoes to prevent foot complications. The physician managing the beneficiary's diabetic condition must document and certify the beneficiary's need for therapeutic shoes. To be covered by Medicare, therapeutic shoes must be prescribed by a podiatrist or other qualified physician, and furnished or fitted by a podiatrist or other qualified physician. The Medicare deductible and copayment or coinsurance applies to this benefit. More details on this benefit are provided in the Medlearn Matters link below. Insulin pumps and the insulin used with the pump are also covered by Medicare for beneficiaries who meet certain conditions, described in the Medlearn Matters link below. The Medicare deductible and copayment or coinsurance apply to this benefit. Coverage for insulin not used with insulin pumps begins in 2006 under Medicare Part D. Other Medical Services for People with Diabetes Medicare pays for other medical services that are important for people with diabetes to receive. These include: - Foot care
- Hemoglobic A1c tests
- Medical nutrition therapy
- Glaucoma screening
- Influenza and pneumococcal vaccinations
Preventive Services Educational Products For Health Care Professionals ~ CMS has developed a variety of educational products for health care professionals to help increase awareness of preventive services covered by Medicare and provide coverage and billing information needed to effectively bill Medicare for preventive services provided to Medicare patients. The Medicare Learning Network (MLN) is the brand name for official CMS educational products and information for Medicare fee-for-service providers. For additional information visit the Medicare Learning Network's web page. (See Related Links Inside CMS below for link a list of available products and to the MLN web page.)
Page Last Modified: 12/14/2005 12:00:00 AM
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