Association of Diabetes Care & Education Specialists

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Reimbursement for DSMT is so Low--Is it worth it?

May 26, 2015

The Texas Medical Foundation (TMF) had a very informative and enlightening webinar recently encouraging primary care settings to provide DSMT. I was pleasantly surprised to discover that the Centers for Medicare and Medicaid Services had increased the reimbursement for G0108 (Diabetes outpatient self-management training services, individual each 30 minutes) and G0109 (Diabetes outpatient self-management training services, group session-two persons or more-each 30 minutes) for accredited/recognized programs to $53.32 and $18.10, respectively.

I practice in Texas and Medicaid does not reimburse for DSMT. However, insurances do reimburse and usually follow the Medicare reimbursement rates. Our clinic is considering becoming a DEAP provider now that we have a flow for the Shared Medical Appointments. Several benefits of accreditation/recognition would be the additional revenue generated separate from the medical encounter and the collection and submission of data to track and report outcomes. However, there is no specific billing code for shared medical appointments that I know of. So, one of our concerns is whether the financial reimbursement would be sufficient to cover the cost of hiring a diabetes educator.

While we know DSMT is important and patients should receive it, how can a program remain viable and sustainable when reimbursement is so low? What do you think about the current reimbursement rates? Does your state’s Medicaid program reimburse for DSMT?

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