The South Dakota Medical Assistance Program has a coverage policy for Diabetes Self-Management Education. This service is reimbursable when delivered to an eligible Medical Assistance recipient by a program certified by the American Diabetes Association or recognized by the South Dakota Department of Health.
The coverage guidelines are not intended to exclude individuals who have not received any prior diabetes education. Provider questions may be directed to 1-800-452-7691 or 605-773-3495.
Medical providers must complete an application and agreement form in order to enroll in the Diabetes Management Education Program. The agreement establishes contractual relations with the provider to ensure the provider adheres to rules and regulations established by South Dakota administrative rule and codified law.
The following forms must be completed:
Outpatient diabetes self-management education is a covered service when one of the following conditions are met:
The provider of outpatient self-management education must maintain the following documentation:
Outpatient diabetes self-management education will be reimbursable when delivered by an American Diabetes Association or South Dakota Department of Health recognized program and a claim is submitted by an enrolled provider such as a hospital or clinic.
Diabetes self-management education is not separately reimbursable when:
Diabetes self-management education is also covered for individuals under the age of 21 when prescribed by a physician and referred by the primary care provider.
A claim for diabetes self-management education may be submitted by an enrolled Diabetes Education program that has been certified by the American Diabetes Association or the South Dakota Department of Health.
The claim must be submitted on a CMS 1500 form and must contain the following information:
Payment for services covered under the provisions of this chapter is limited to the following:
- G0108 Diabetes Education, Individual, each 30-minute unit - $18.00
- G0109 Diabetes Education, Group, each 30-minute unit - $13.00
- S9455 Diabetes Education, Follow-up, Group, each 60-minute unit - $25.00
- S9460 Diabetes Education, Follow-up, Individual, each 60-minute unit - $35.00
Cost sharing for diabetes education services is $3 for each unit of service billed. Eligible Medical Assistance recipients under the age of 19 years or under the Home and Community Based Services program are not required to participate in the cost of medical care.