Medical Billing and Coding Services

With value-based reimbursement slowly dominating healthcare revenue, the demand for technological solutions that support the new payment structure increased.

The CPT® code 99211 is the only E&M code used for ‘incident to’ billing available to the physician clinic‘s ancillary staff members. Some of the other codes (in the range of 99212–99499) can, however, be billed ‘incident to’ by non-physician providers (NP, PA, CNS).

Most payors cover and pay for DSMT in the primary care setting, although they may use different terminology, e.g., diabetes self-management training (DSMT) or diabetes education. Unfortunately, diabetes education is an underused service, perhaps because of a lack of clarity about how to obtain reimbursement.

The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), under certain conditions. Becoming familiar with the Medicare DSMT reimbursement guidelines can help increase a DSMES service’s financial sustainability.

The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), under certain conditions. Becoming familiar with the Medicare DSMT reimbursement guidelines can help increase a DSMES service’s financial sustainability.