CMS Pub. 100-02, ch. 15, § 300.4.1

The “incident to” requirements of section 1861(s)(2)(A) of the Social Security Act do not

apply to DSMT services. Section 1861 (s)(2)(S) of the Act authorizes DSMT in a stand

alone provision. DSMT services are covered only if the physician or qualified non-physician practitioner who is managing the beneficiary’s diabetic condition certifies that

such services are needed and refers the patient to the DSMT program. The referral must

be done under a comprehensive plan of care related to the beneficiary’s diabetic

condition. Training may be furnished by a physician, individual, or entity that meets the

following conditions:

• Furnishes other services for which direct Medicare payment may be made;

• May properly receive Medicare payment under 42CFR 424.73 or 424.80

which set forth prohibitions on assignment and reassignment of claims;

• Submits necessary documentation to, and is accredited by, an accreditation

organization approved by CMS under 42CFR 410.142 to meet one of the sets

of quality standards described in 42 CFR 410.144; and

Provides documentation to CMS, as requested, including diabetes outcome

measurements set forth at CFR 410.146.

Any certified providers or suppliers that provide other individual items or services under

Medicare that meet CMS’s quality standards and meet the conditions for CMS approval

pursuant to 42 CFR 410.145, may receive reimbursement for diabetes training. Entities

are more likely than individuals to bill for DSMT services. These certified providers

must be currently receiving payment for other Medicare services.