CMS Pub. 100-02, ch. 15, § 300.1

Medicare Part B covers 10 hours of initial training for a beneficiary who

has been diagnosed with diabetes.

Diabetes is diabetes mellitus, a condition of abnormal glucose

metabolism diagnosed using the following criteria;

• a fasting blood sugar greater than or equal to 126 mg/dL

on two different occasions;

• a 2 hour post-glucose challenge greater than or equal to 200

mg/dL on 2 different occasions; or

o a random glucose test over 200 mg/dL for a person

with symptoms of uncontrolled diabetes.

Documentation that the beneficiary is diabetic is maintained in the

beneficiary’s medical record.

Beneficiaries are eligible to receive follow-up training each calendar

year following the year in which they have been certified as requiring

initial training or they may receive follow-up training when ordered

even if Medicare does not have documentation that initial training has

been received. In that instance, contractors shall not deny the follow-up service even though there is no initial training recorded.

Effective for claims with dates of service on or after January 1, 2024, “diabetes”

means diabetes mellitus, a condition of abnormal glucose metabolism. The specific

test-based clinical criteria described above is no longer included in the regulatory

definition of “diabetes” for purposes of Diabetes Self-Management Training (DSMT)

services at 42 CFR 410.140.