You are eligible for Diabetes Self-Management Training and Medical Nutrition Therapy if certain criteria are met. The following information was taken from the official government booklet called “Medicare Coverage of Diabetes Supplies & Services.”
Diabetes Self-Management Training
(DSMT) – 10 hours initially
Your doctor must prescribe this training for you (written prescription) for Medicare to cover it.
You can get DSMT if – during the past 12 months –
- You’ve been recently diagnosed with diabetes, or
- You’ve changed from taking no diabetes medicine to taking oral meds, or
- You’ve changed from taking oral diabetes meds to insulin, or
- You have had diabetes and recently become eligible for Medicare, or
- You are at risk for complications from diabetes if:
- you’ve had problems controlling your blood sugar, or
- you’ve been treated in the Emergency Room or have stayed overnight in a hospital because of your diabetes, or
- you’ve been diagnosed with eye disease related to diabetes, or
- you’ve had a lack of feeling in your feet or some other foot problems like ulcers, deformities, or have had an amputation, or
- you’ve been diagnosed with kidney disease related to diabetes.
You must get this training from a certified diabetes self-management education program under a plan of care prepared by your doctor or qualified non-doctor practitioner. These programs are certified by the American Diabetes Association.
Classes are taught by health care providers who have special training in diabetes education.
You are covered to get a total of 10 hours of initial training within a continuous 12-month period. The initial training must be completed no more than 12 months from the time you start the training.
One of the 10 initial hours can be given on a one-to-one basis (for instance, for assessment or for insulin training); the other nine hours must be training in a group class.
Follow-up DSMT – 2 hours each year
To be eligible for two more hours of follow-up training each year after the year you received initial training, you must get another written order from your doctor. The two hours can be with a group class or you may have one-on-one sessions.
Medical Nutrition Therapy
(MNT) – 3 hours initially
In addition to DSMT, Medical Nutrition Therapy services are also covered for people with diabetes. To be eligible for this service, your doctor must prescribe it (written prescription).
These services must be given by a Registered Dietitian. Services include:
- an initial nutrition and lifestyle assessment
- nutrition counseling (how to follow an individualized diabetic meal plan)
- how to manage lifestyle factors that affect your diabetes, and
- follow-up visits to check on your progress in managing your diet.
Medicare covers three hours of one-on-one MNT services the first year you receive the service, and two hours each year after that.
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