CMS Pub. 100-04, ch. 12, § 190.3.6

Telehealth Service

(Rev. 4173, Issued: 11-30-18, Effective: 01-01- 19, Implementation: 01-02-19)

Individual and group DSMT services may be paid as a Medicare telehealth service. Before

03-11-2016, this manual provision required that 1 hour of the 10 hour DSMT benefit’s

initial training must be furnished in-person to allow for effective injection training.

Because injection training is not always clinically indicated, we are revising this

provision to permit all 10 hours of the initial training and the two (2) hours of annual

follow-up training to be furnished via telehealth in those cases when injection training is

not applicable. The in-person injection training, when provided, may be furnished through

either individual or group DSMT services. By reporting place of service (POS) 02 or the –

GT or –GQ modifier with HCPCS code G0108 (Diabetes outpatient self-management

training services, individual, per 30 minutes) or G0109 (Diabetes outpatient self-management

training services, group session (2 or more), per 30 minutes), the distant site practitioner

attests that the beneficiary has received or will receive 1 hour of in-person DSMT services

for purposes of injection training when it is indicated during the year following the initial

DSMT service or any calendar year’s 2 hours of follow-up training.

As specified in 42 CFR 410.141(e) and stated in Pub. 100-02, Medicare Benefit Policy

Manual, chapter 15, section 300.2, individual and group DSMT services may be furnished by

a physician, other individual, or entity that furnishes other items or services for which direct

Medicare payment may be made and that submits necessary documentation to, and is

accredited by a national accreditation organization approved by CMS. However, consistent

with the statutory requirements of section 1834(m)(1) of the Act, as provided in 42 CFR

410.78(b)(1) and (b)(2) and stated in section 190.6 of this chapter, Medicare telehealth

services, including individual and group DSMT services furnished as a telehealth service,

could only be furnished by a physician, PA, NP, CNS, CNM , clinical psychologist, clinical

social worker, or registered dietitian or nutrition professional, as applicable.