HCPCS code G0108, G0109 - covered ICD 10 and frequency usage

Diabetes Self-Management Training (DSMT) 

HCPCS/CPT Codes

G0108 – DSMT, individual, per 30 minutes
G0109 – DSMT, group (2 or more), per 30 minutes

ICD-10-CM Codes

See https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html for individual Change Requests (CRs) and coding translations for ICD-10

Who Is Covered
Certain Medicare beneficiaries who:
• Are diagnosed with diabetes; and
• Who receive an order for DSMT from the physician or qualified non-physician practitioner (NPP) treating the beneficiary’s diabetes

Frequency

• Initial year: Up to 10 hours of initial training within a continuous 12-month period; or

• Subsequent years: Up to 2 hours of follow-up training each year after the initial year

Beneficiary Pays

• Copayment/coinsurance applies
• Deductible applies

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