Wiki Billing for Diabetes Self Mgmt G0108 and G0109

[crissy.hill@ccsmed.com]

Researching billing the Medicare AB MAC for diabetes self management training via telehealth for both individuals and possible groups (with prior permission of the patients participating).
On the CMS1500, do you bill the units for these HCPCS as minutes like 120 units to represent 2 hours of per 30 minutes or would you bill 4 units for 2 hours of per 30 minutes?

Any guidance is appreciated, thank you!

 

[thomas7331]

One unit is 30 minutes for these codes, so a 2-hour session would be 4 units. CMS does not allow rounding of time on these particular codes, so each 30 minutes must be completed in order to bill a unit.

There are a lot of regulations and limitations on these codes, including the requirement that the provider be part of a training program accredited by one of the two approved national diabetes organizations (ADA or AADE). The documentation requirements are quite burdensome and claims are frequently audited by CMS, in my experience, so I'd recommend doing your research thoroughly on this prior to offering these services and trying to get payment. The two diabetes organizations have excellent detailed guidance on their web sites. Here's a sample link listing all of the requirements you are up against:

NGS Medicare - DSMT Manual

 

[crissy.hill@ccsmed.com]

One unit is 30 minutes for these codes, so a 2-hour session would be 4 units. CMS does not allow rounding of time on these particular codes, so each 30 minutes must be completed in order to bill a unit.

There are a lot of regulations and limitations on these codes, including the requirement that the provider be part of a training program accredited by one of the two approved national diabetes organizations (ADA or AADE). The documentation requirements are quite burdensome and claims are frequently audited by CMS, in my experience, so I'd recommend doing your research thoroughly on this prior to offering these services and trying to get payment. The two diabetes organizations have excellent detailed guidance on their web sites. Here's a sample link listing all of the requirements you are up against:

NGS Medicare - DSMT Manual

Very helpful, thanks so much for the advice!