Page 285 - Medicare Benefit Policy Manual

• Does not exceed a total of 10 hours* (the 10 hours of training can be done in any
combination of 1/2 hour increments);

• With the exception of 1 hour of individual training, training is usually furnished
in a group setting, which can contain other patients besides Medicare
beneficiaries, and;

• One hour of individual training may be used for any part of the training including
insulin training.

* When a claim contains a DSMT HCPCS code and the associated units cause the total
time for the DSMT initial year to exceed '10' hours, a CWF error will set.

B - Follow-Up Training

Medicare covers follow-up training under the following conditions:

• No more than 2 hours individual or group training per beneficiary per year;

• Group training consists of 2 to 20 individuals who need not all be Medicare
beneficiaries;

• Follow-up training for subsequent years is based on a 12 month calendar after
completion of the full 10 hours of initial training;

• Follow-up training is furnished in increments of no less than one-half hour*; and

• The physician (or qualified non-physician practitioner) treating the beneficiary
must document in the beneficiary's medical record that the beneficiary is a
diabetic.

*When a claim contains a DSMT HCPCS code and the associated units cause the
total time for any follow-up year to exceed 2 hours, a CWF error will set.

300.4 - Coverage Requirements for Individual Training
(Rev. 72, Issued: 05-25-07; Effective: 07-01-07; Implementation: 07-02-07)

Medicare covers training on an individual basis for a Medicare beneficiary under any of
the following conditions:

• No group session is available within 2 months of the date the training is ordered;

• The beneficiary’s physician (or qualified non-physician practitioner) documents
in the beneficiary’s medical record that the beneficiary has special needs resulting
from conditions, such as severe vision, hearing or language limitations or other