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Reimbursement FAQs
Diabetes Reimbursement Frequently Asked Questions
We've helped thousands of healthcare professionals who provide DSMES navigate their diabetes reimbursement challenges, allowing them to be successful and continue to serve people with diabetes in their communities. Here are answers to the most frequently asked insurance reimbursement and billing questions.
To bill Medicare, the provider must have a DSMES program accredited by ADCES or recognized by ADA and must also be a Medicare provider billing Medicare for another reimbursable service before they can bill for DSMT. DSMES programs will have a sponsor that is recognized as a billing provider. (Sponsors can be individuals or entities.) Sponsors do not have to be a member of the DSMES team but will be part of the organization where DSMES is delivered.
RNs and CDCESs are not recognized as Medicare providers, so they're unable to bill under their own provider numbers. To bill Medicare for DSMT, you must have an accredited program through either ADCES or ADA. Billing for DSMT would then be done under the provider number that is the sponsor of the accredited program (i.e., RD, physician, advanced practitioner or hospital).
RNs and other team members are not recognized as Medicare providers, so they cannot bill for services under their own provider numbers. To bill Medicare for DSMT, you must have an accredited program through either ADCES or ADA. Billing for DSMT would then be done under the provider number that is the sponsor of the accredited program (i.e., RD, physician, advanced practitioner, or hospital).
A pharmacist is one of several key team members in an ADCES-accredited or ADA-recognized DSMT program, but since they're not recognized as individual DSMT billing providers, they cannot bill under their own NPI. The billing for DSMT would need to be done under the pharmacy’s NPI number assigned to the DSMES program (on the accreditation certificate). Many pharmacies already bill services to Medicare either as a DME supplier or Part D provider, but the pharmacy must submit the Form CMS-855B application to become a Part B provider.
They must enroll as a Medicare Part B provider even if they already completed Form CMS-855S. For more information, visit the CMS Medicare Provider Enrollment page.