Does Medicare Cover Diabetes Self-Management Training?

Diabetes self-management training, or DSMT, is a program that helps people manage their diabetes diagnosis to prevent additional complications.

If left untreated, diabetes can cause serious side effects, including kidney disease, eye disease and stroke.

The Balanced Budget Act of 1997 established Medicare coverage for DSMT services in an effort to reduce health care costs and improve health outcomes for diabetes patients.

DSMT classes often take place in a different setting outside your doctor’s office, such as at a hospital, clinic or medical office.

Diabetes self-management training incorporates your specific needs, goals and life experiences into a program guided by evidence-based standards.

A diabetes care and education specialist can help you create a plan to stay healthy while also giving you resources and ongoing support to incorporate that plan into your daily life.

According to the American Diabetes Association, the overall goals of diabetes self-management education are to support informed decision-making, self-care behaviors and facilitate collaboration with a health care team.

DSMT is not the same as medical nutrition therapy, a different service provided by Medicare that features a more intensive, comprehensive nutrition program.

As of 2022, there were 1,614 DSMT programs accredited by the American Association of Diabetic Educators along with an additional 2,119 sites associated with these programs, according to the Centers for Medicare & Medicaid Services.

Medicare Part B covers outpatient diabetes self-management training if you’ve been diagnosed with diabetes.

You must have a written note from your doctor or qualified practitioner to start your self-care training.

DSMT programs must be accredited as meeting quality standards by a CMS-approved national accreditation organization.

Group training may be substituted for individual training if group sessions aren’t available in your area, or if your doctor says you have special needs that would benefit from individual training sessions.

You may also be able to get DSMT from a practitioner as a telehealth service.

Medicare doesn’t consider DSMT a free preventive service because it helps you better manage a current condition.

Therefore, you will likely have some out-of-pocket cost if your doctor recommends DSMT.

You’ll pay 20 percent of the Medicare-approved cost, and the Part B deductible applies. You may owe less if you have secondary health insurance coverage, such as Medicaid.