Page 287 - Medicare Benefit Policy Manual

Payment for DSMT may only be made to any provider that bills Medicare for other
individual Medicare services and may be made only for training sessions actually
attended by the beneficiary and documented on attendance sheets.

See Pub. 100-04, chapter 18, section 120 for specific payment information for physicians
and all provider types.

300.5.1 - Special Claims Processing Instructions for A/B MACs (A)
(Rev. 24, Issued: 10-29-04, Effective: 01-01-05, Implementation: 01-03-05)

• Coding and Payment Requirements

The provider bills for DSMT on Form CMS-1450 or its electronic equivalent.
The cost of the service is billed under revenue code 942 in FL 42 “Revenue
Code.” The provider will report HCPCS codes G0108 or G0109 in FL 44
“HCPCS/Rates.” The definition of the HCPCS code used should be entered
in FL 43 “Description.”

• Applicable Bill Types

The appropriate bill types are 12x, 22x, 13x, 34x (can be billed if service is
outside of the treatment plan), 72x, 74x, 75x, 83x and 85x.

310 – Kidney Disease Patient Education Services
(Rev. 117; Issued: 12-18-09; Effective Date: 01-01-10; Implementation Date: 04-
05-10)

By definition, chronic kidney disease (CKD) is kidney damage for 3 months or longer,
regardless of the cause of kidney damage. CKD typically evolves over a long period of
time and patients may not have symptoms until significant, possibly irreversible, damage
has been done. Complications can develop from kidneys that do not function properly,
such as high blood pressure, anemia, and weak bones. When CKD progresses, it may
lead to kidney failure, which requires artificial means to perform kidney functions
(dialysis) or a kidney transplant to maintain life.

Patients can be classified into 5 stages based on their glomerular filtration rate (GFR,
how quickly blood is filtered through the kidneys), with stage I having kidney damage
with normal or increased GFR to stage V with kidney failure, also called end-stage renal
disease (ESRD). Once patients with CKD are identified, treatment is available to help
prevent complications of decreased kidney function, slow the progression of kidney
disease, and reduce the risk of other diseases such as heart disease.