US · guidance
CMS Pub. 100-04, ch. 18, § 120.1
Coding and Payment of DSMT Services
The following HCPCS codes are used to report DSMT:
• G0108 - Diabetes outpatient self-management training services, individual, per 30 minutes.
• G0109 - Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.
The type of service for these codes is 1.
Payment to physicians and providers for outpatient DSMT is made as follows:
Type of Facility Payment Method Type of Bill
Physician (billed to
the A/B MAC (B))
MPFS NA
Hospitals subject to
OPPS
MPFS 12X, 13X
Method I and Method
II Critical Access
Hospitals (CAHs)
(technical services)
101% of reasonable cost 12X and 85X
Type of Facility Payment Method Type of Bill
Indian Health Service
(IHS) providers
billing hospital
outpatient Part B
OMB-approved
outpatient per visit all
inclusive rate (AIR)
13X
IHS providers billing
inpatient Part B
All-inclusive inpatient
ancillary per diem rate
12X
IHS CAHs billing
outpatient Part B
101% of the all-inclusive facility
specific per visit rate
85X
IHS CAHs billing
inpatient Part B
101% of the all-inclusive facility
specific per diem rate
12X
FQHCs* All-inclusive encounter
rate with other qualified
services. Separate visit
payment available with
HCPCS.
73X
Skilled Nursing
Facilities **
MPFS non-facility rate 22X, 23X
Maryland Hospitals
under jurisdiction of
the Health Services
Cost Review
Commission
(HSCRC)
94% of provider
submitted charges in
accordance with the
terms of the Maryland
Waiver
12X, 13X
Home Health
Agencies (can be
billed only if the
service is provided
outside of the
treatment plan)
MPFS non-facility rate 34X
* Effective January 1, 2006, payment for DSMT provided in an FQHC that meets all of the requirements as above,
may be made in addition to one other visit the beneficiary had during the same day, if this qualifying visit is billed on
TOB 73X, with HCPCS G0108 or G0109, and revenue codes 0520, 0521, 0522, 0524, 0525, 0527, 0528, or 0900.
** The SNF consolidated billing provision allows separate part B payment for training services for beneficiaries that
are in skilled Part A SNF stays, however, the SNF must submit these services on a 22 bill type. Training services
provided by other provider types must be reimbursed by X the SNF.
NOTE: An ESRD facility is a reasonable site for this service, however, because it is required to provide dietician and
nutritional services as part of the care covered in the composite rate, ESRD facilities are not allowed to bill for it
separately and do not receive separate reimbursement. Likewise, an RHC is a reasonable site for this service,
however it must be provided in an RHC with other qualifying services and paid at the all-inclusive encounter rate.
Deductible and co-insurance apply.
History
(Rev. 1255, Issued: 05-25-07; Effective: 07-01-07; Implementation: 07-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b3eba7c4a860e6ec87ccb535034ffcb4220ef28fc433ed2a398ae6ac72688746
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