I. Medicare Beneficiary Information
II. Provider Medical Nutrition Therapy Information
I. Medicare Beneficiary Information:
"Medicare Coverage of Diabetes Related Supplies and Services" is a revised publication on Medicare coverage of diabetes supplies and services. It is available by downloading a PDF file (318.5 KB) from the Centers for Medicare and Medicaid Services site. Also, a free copy can be obtained from the website or by calling 1.800.MEDICARE (1.800.633.4227). TTY users should call 1.877.486.2048. Some of this information is included below:
- Self-testing equipment and supplies:
Medicare Part B covered diabetes supplies: Coverage for blood sugar (glucose) monitors, blood sugar test strips, lancet devices and lancets, and glucose control solutions for checking accuracy of the testing equipment and test strips.
Who is covered: All people with Medicare who have diabetes (insulin users and non-users). These include glucose testing monitors, blood glucose test strips, lancet devices and lancets, and glucose control solutions. There may be some limits on supplies or how often you get them. For more information about diabetic supplies, call your Durable Medical Equipment Regional Carrier.
How do I get these covered supplies? To get your Medicare-covered diabetes equipment and supplies under Medicare, you need a prescription from your doctor. The prescription should say:
- That you have diabetes;
- How many test strips and lancets you need for one month;
- What kind of blood sugar monitor you need and why you need it (If you need a special monitor because of vision problems, the doctor must also explain why you need this special monitor.);
- Whether you use insulin or not; and
- How often you should test your blood sugar.
- Therapeutic shoes: Medicare also covers therapeutic shoes for people with diabetes. Medicare coverage: Medicare covers depth-inlay shoes, custom-molded shoes and shoe inserts for people with diabetes who qualify under Medicare Part B.
How you qualify: Your doctor must certify that you:
- Have diabetes.
- Have at least one of the following conditions in one or both feet:
- partial or complete foot amputation
- past foot ulcers
- calluses that could lead to ulcers
- nerve damage because of diabetes with signs of problems with calluses
- poor circulation
- deformed foot; and
- Are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.
- Insulin Pumps: Insulin pumps worn outside of the body, including the insulin used with the pump may be covered for some people with Medicare who have diabetes and who meet certain conditions.
How you qualify: If you need to use an insulin pump, your doctor will prescribe this for you.
- Referrals for more information: If you have questions about durable medical equipment, including diabetic supplies, call your Durable Medical Equipment Regional Carrier (DMERC).
- Diabetes self-management training: Medicare Part B beneficiaries with diabetes will initially receive one hour of individual training or assessment and nine hours of group training or classes. The regulation also allows two hours of annual follow-up training that can be given on an individual basis or by group. The doctor must prescribe this follow-up training also.
Medicare coverage: To qualify for this training, a beneficiary must be either newly diagnosed with diabetes, or did not receive training at the time of diagnosis, or is at significant risk for complications from the disease. For beneficiaries with special needs such as reduced vision or hearing, physicians will be able to order individual training for all sessions.
- Medical Nutrition Therapy Services - Medical nutrition therapy services are covered for people with diabetes when prescribed by a doctor.
Medicare coverage: These services can be given by a registered dietitian or nutrition professional and includes an initial nutrition and lifestyle assessment, nutrition counseling, how to manage lifestyle factors that affect your diet, and follow up visits to check on your progress in managing your diet.
- Hemoglobin A1c Tests: A lab test ordered by the physician to measure how well your blood sugar has been controlled over the past 2 to 3 months.
Medicare Coverage: Any Medicare beneficiary with diabetes is covered if their physician orders this test.
- Foot Care:
Medicare Coverage: One foot exam by a podiatrist or other foot care specialist every 6 months if the beneficiary has diabetes-related nerve damage in either foot. Medicare may cover more frequent visits to a foot specialist if you have had a non-traumatic amputation of all or part of you foot or your feet have changed in appearance indicating a serious foot disease.
- Special Eye Exams:
Medicare Coverage: Medicare beneficiaries with diabetes can get a dilated eye exam to check for diabetic eye disease.
- Glaucoma screening: Medicare Part B covered preventive services: Once every 12 months. Must be done or supervised by an eye doctor who is legally allowed to do this service in your state.
Who is covered: People with Medicare who are at high risk for glaucoma, including people with diabetes or family history of glaucoma.
- Flu and pneumococcal pneumonia shots (vaccinations):
Medicare Part B covered preventive services:
- Flu Shot - Once a year in the fall or winter.
- Pneumococcal Pneumonia Shot - One shot may be all you ever need. Ask your doctor.
Who is covered: All people with Medicare.
- Referrals for more information: If you have general questions about Medicare Part B, call your Medicare Carrier.
As a Medicare patient, you have certain guaranteed rights. You have them whether you are in the Original Medicare Plan, a Medicare Managed Care Plan, or a Medicare Private Fee-for-Service plan. These rights and protections are described in your Medicare & You handbook and include the right to appeal any decision about your Medicare services. For more detailed information about your rights and protections, call 1.800.MEDICARE (1.800.633.4227) to get a free copy of the booklet Your Medicare Rights and Protections.
For more Information on Medicare: Centers for Medicare and Medicaid Services
II. A PROVIDERS Quick Guide to the Medicare MNT Benefit
||Type 1 diabetes, Type 2 diabetes, gestational diabetes; non-dialysis kidney disease, and post kidney transplants are covered.|
- Practice settings (e.g., private practice, physician offices, ambulatory clinics); hospital outpatient departments; other outpatient settings.
- Excluded: inpatient hospital setting; skilled nursing facilities.
|Medicare MNT Benefit and Diabetes Self-Management Training Benefit
- Through the National Coverage Determination (NCD) decision, Centers for Medicare and Medicaid Services (CMS) indicated the Medicare Medical Nutrition Therapy (MNT) benefit basic coverage (year 1) = 3 hours. CMS indicated "an episode of care typically includes 1 hour of initial assessment and four 30 minute follow-up interventions during the first year." Additional hours are considered to be medically necessary and covered if the treating physician determines there is a change in medical condition, diagnosis, or treatment regimen that requires a change in MNT and orders additional hours during that episode of care. Follow-up (year 2) = 2 hours.
- Effective October 1, 2002, Medicare will cover DSMT (Diabetes Self-Management Training) and MNT in initial and subsequent years without decreasing either benefit as long as DSMT and MNT are not provided on the same date of service.
|Medicare MNT Provider Qualifications and Requirements
||Registered dietitian or nutrition professional who meet all the following criteria:
- BS degree in nutrition or dietetics.
- Completion of 900 hours of supervised dietetics practice.
- Licensed or certified as dietitian or nutrition professional by State in which services are performed (if State does not provide licensure or certification, meets other criteria established by Secretary).
- Grandfathers dietitian, nutritional professionals licensed or certified as of 12/21/00.
- Physician's referral for MNT is required. The physician can be the treating physician or specialist who is treating the beneficiary.
- Referral must indicate the order for MNT, beneficiaries' diagnosis (related to covered MNT benefit), physician's Unique Physician Identification Number (UPIN) and referral must be signed by physician.
- Documentation by RD of furnished MNT (initial and follow-up MNT) in beneficiary's medical record.
- When furnishing the MNT benefit, the Medicare regulations state that recognized protocols, such as those developed by the American Dietetic Association must be used.
- The guides are now available for purchase on CD-Rom from American Dietetic Association, 1-800-877-1600.