Page 284 - Medicare Benefit Policy Manual

Association, American Association of Diabetes Educators and the Indian Health Service
as approved national accreditation organizations. Programs without accreditation by a
CMS-approved national accreditation organization are not covered. Certified providers
may be asked to submit updated accreditation documents at any time or to submit
outcome data to an organization designated by CMS.

Enrollment of DMEPOS Suppliers

The DMEPOS suppliers are reimbursed for diabetes training through A/B MACs (B). In
order to file claims for DSMT, a DMEPOS supplier must be enrolled in the Medicare
program with the National Supplier Clearinghouse (NSC). The supplier must also meet
the quality standards of a CMS-approved national accreditation organization as stated
above. DMEPOS suppliers must obtain a provider number from the A/B MAC (B) in
order to bill for DSMT.

The A/B MAC (B) requires a completed Form CMS-855, along with an accreditation
certificate as part of the provider application process. After it has been determined that
the quality standards are met, a billing number is assigned to the supplier. Once a
supplier has received a National Provider Identification (NPI) number, the supplier can
begin receiving reimbursement for this service.

A/B MACs (B) should contact the National Supplier Clearinghouse (NSC) according to
the instruction in Pub 100-08, the Medicare Program Integrity Manual, Chapter 10,
“Healthcare Provider/Supplier Enrollment,” to verify an applicant is currently enrolled
and eligible to receive direct payment from the Medicare program.

The applicant is assigned specialty 87.

Any DMEPOS supplier that has its billing privileges deactivated or revoked by the NSC
will also have the billing number deactivated by the A/B MAC (B).

300.3 - Frequency of Training
(Rev. 72, Issued: 05-25-07; Effective: 07-01-07; Implementation: 07-02-07)

A - Initial Training

The initial year for DSMT is the 12 month period following the initial date.

Medicare will cover initial training that meets the following conditions:

• Is furnished to a beneficiary who has not previously received initial or follow-up
training under HCPCS codes G0108 or G0109;

• Is furnished within a continuous 12-month period;