Perspectives on Diabetes Care

Medicare Guidelines for DSMES and MNT: Your Questions Answered

Mar 15, 2021, 09:00 AM

By Sacha Uelmen, RDN, CDCES, Director of Diabetes Education & Prevention Programs

What needs to be on the referral for DSMES and MNT? How many hours of DSMES and MNT are available to Medicare beneficiaries? Who can refer for these services? These are just a few of the common questions we receive at ADCES every day related to billing for accredited DSMES programs and MNT. 

When the public health emergency began in 2020, we quickly learned that too many of our DSMES programs and providers were not getting the guidance and support they needed from their own billing specialists to navigate the changes happening in reimbursement. When we surveyed accredited and recognized programs in September 2020, we learned that 32% of respondents saw an impact on their DSMES services due to confusion about CMS coverage. 

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The evidence is clear, DSMES improves A1C, reduces the onset/worsening of diabetes-related complications, enhances the quality of life and fosters healthy coping strategies to decrease diabetes-related distress.

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DSMES Quality Coordinators and team members must take an active role to reduce barriers to accessing these critical services and ensure their services are appropriately reimbursed. Health systems and clinical organizations can maximize billing potential by facilitating the reimbursement process, ensuring all applicable codes are utilized and submitted appropriately according to the 2020 DSMES Consensus Report. That report also identified barriers to DSMES including referring provider confusion about when and how to make referrals, and referral to DSMES services not being effectively embedded in health system service structures. One solution: provide seamless referral and access to programs.

ADCES teamed up with the Academy of Nutrition & Dietetics and American Diabetes Association in late 2020 to update the DSMT/MNT Services Order Form that we revised with Academy in 2017. The goal was to reduce existing confusion and provide a form that programs could easily print or adapt for their electronic medical record or customize to meet their program’s needs.

The order form is accompanied by an informational backgrounder that provides an overview of Medicare regulations and benefit coverage policies for DSMT and MNT, examples of coordination of both benefits, an overview of private payer coverage of other CPT codes and helpful references and links. The order form can be printed or used as a template to build a custom or electronic referral order.

Don’t let referral confusion be a barrier to access your DSMES and MNT services!

• Download the updated order form at DiabetesEducator.org/ReferDSMES.
• Review with your billing team to ensure your referral process is in compliance with Medicare guidelines.
• Read the backgrounder and be sure you understand the benefits that Medicare beneficiaries with diabetes are entitled to every year and how to get reimbursed for the services you provide.

Remember, anyone can initiate the referral, but the provider managing the beneficiaries’ diabetes must sign it.