CMS Pub. 100-04, ch. 4, § 300.1

A. General Conditions of Coverage

The following are the general conditions of coverage:

• A physician must make a referral and indicate a diagnosis of diabetes or renal disease.

Physician is defined in §1861(r)(l) of the Act.

• The number of hours covered in an episode of care may not be exceeded unless a

second referral is received from the physician;

• Services may be provided either on an individual or group basis without restrictions

and;

• For a beneficiary with a diagnosis of diabetes, DSMT and MNT services can be

provided within the same time period, and the maximum number of hours allowed under

each benefit are covered. The only exception is that DSMT and MNT may not be

provided on the same day to the same beneficiary. For a beneficiary with a diagnosis of

diabetes who has received DSMT and is also diagnosed with renal disease in the same

episode of care, the beneficiary may receive MNT services based on a change in medical

condition, diagnosis, or treatment as stated in 42 CFR 410.132(b)(5).

B. Limitations on Coverage

The following limitations apply:

• MNT services are not covered for beneficiaries receiving maintenance dialysis for

which payment is made under section 1881 of the Act.

• A beneficiary may not receive MNT and DSMT on the same day.