Make a DSMES Referral
Improve outcomes for people with diabetes by referring patients to diabetes care and education specialists.
Refer to DSMES
Make a DSMES Referral ─ Add Value to Your Practice & Patients’ Lives
Diabetes care and education specialists improve outcomes for people with diabetes. Partner and refer to a diabetes self-management education and support (DSMES) program to add value to your practice and patients’ lives.
Refer to a DSMES Program & Partner to Make a Difference
More than 100 million Americans are affected by diabetes or prediabetes and that number is only expected to grow. Reduce the impact this will have on your time and practice and make a difference in your patients’ lives with personalized diabetes care. Refer to a DSMES program in your area, and possibly even in your own health system. These programs employ diabetes care and education specialists, also called diabetes educators.
Diabetes care and education specialists help people with diabetes:
Improve Patient Outcomes & Lower Costs
Diabetes care and education specialists help people with diabetes achieve behavior change goals and implement technology into their everyday lives. Research shows this improves outcomes and reduces costs for you, your health system and your patients by:
Empower Your Patients & Help Change Lives
While you manage your patients’ care, diabetes care and education specialists focus on empowerment. They teach, coach and guide your patients to understand diabetes in the context of their lives and help them set and meet behavior change goals that improve their health.
Support Your Practice & Ease Your Workload
Diabetes care and education specialists provide essential support for both you and your patients.
Practice Efficiency
Increasing your practice’s efficiency by assuming time-consuming patient training, counseling and follow-up discussions.
Patient Care & Progress
Tracking and monitoring your patients’ care and progress and providing you with status reports.
Prevention & Self-Management Training
Helping to delay the onset of diabetes with prevention and self-management training for your patients who are at high risk.
How to Partner with a Diabetes Care and Education Specialist
Consider contracting with, employing or referring your patients to a DSMES program.
There are many accredited DSMES programs in community hospitals, clinics and pharmacies. There’s likely one in your area.
An independent diabetes care and education specialist is a licensed healthcare professional who can bill for their services or partner with another professional who has a provider number. They may contract with one or more physicians from multiple practices.
Add a diabetes care and education specialist to your staff. Diabetes care and education specialist services can often be billed incident to a physician, making reimbursement possible.
Reimbursement for diabetes education often requires the program to be accredited. ADCES’ Diabetes Education Accreditation Program (DEAP) allows physicians to implement their own diabetes education program by contracting with an independent diabetes care and education specialist or directly employing one. Find additional information and the program accreditation application on our DEAP page.
Know When & How To Refer
Know when you should refer your patients to a diabetes care and education specialist or DSMES program. Medicare and most health insurance plans cover DSMES programs.
To qualify for DSMES services, an individual must have the following:
1. Documentation of diagnosis of type 1, type 2 or gestational diabetes
2. Under Medicare and many commercial payers, diagnosis must be made using the following criteria:
- Fasting blood glucose of 126 mg/dL on two separate occasions
- 2-hour post-glucose challenge of ≥200 mg/dL on two separate occasions
- Random glucose test of >200 mg/dL with symptoms of unmanaged diabetes
3. A written referral (see sample forms under How to Refer) from the treating physician or qualified non-physician practitioner, including nurse practitioner, physician assistant, clinical nurse specialist or advanced nurse practitioner
- A new referral is required for follow up visits after one year
We partnered with a number of diabetes organizations, such as AAFP, AAPA, AANP and ADA, to issue guidance on when diabetes self-management education and support is most critical and when it’s necessary to refer patients to DSMES.
- At Diagnosis
- During an annual assessment
- When a person with diabetes faces new complicating factors
- When there is a transition in care
Reimbursement
Medicare reimburses up to 10 hours of DSMT (the term the government and insurers use for DSMES) as a once-in-a-lifetime benefit that must be used within 12 consecutive months when started. Each subsequent calendar year, Medicare reimburses up to two hours of DSMT with a new referral. Most commercial insurers follow Medicare, but it’s best to have each person check with their insurer to verify coverage.
When making a referral, make sure you refer to programs that are accredited by one of the two National Accrediting Organizations for the Centers for Medicare and Medicaid Services (CMS), ADCES and the American Diabetes Association. These programs meet national standards for quality DSMES.
Sample referral forms are available for download and use. Included on the forms is also an order for Medical Nutrition Therapy (MNT), which is often used in conjunction with DSMT. If you’re using an electronic medical record or EMR, it’s helpful to have the referral order built in and easily accessible.
This is designed to make it easy for providers to refer for DSMT and MNT in one quick step.
Background Information on the Diabetes Services Order Form
This provides a summary of DSMT and MNT benefit requirements, as well as examples of how they can be coordinated for qualifying Medicare beneficiaries.
Find a Diabetes Care and Education Specialist & Begin Collaborating
Find a diabetes care and education specialist, and make a referral to collaborate and add value to your practice and patients’ lives. To find a diabetes care and education specialist in your community, click on the orange button below.
Find an Accredited DSMES ProgramPatient Follow Up
Knowing the progress of patient treatment is key to their continued care.
DSMES Program Reporting
The National Standards for Diabetes Self-Management Education and Support requires DSMES programs to share the provided education and participant outcomes to the referring provider, so they’re aware of the patient’s progress after the referral.