Diabetes Self-Management Education and Support, or DSMES, teaches participants how to eat healthy, be active, monitor blood sugar levels, take medication, problem solve, reduce risk for other health conditions, and cope with their disease. It is evidence-based and improves clinical outcomes, health status and quality of life.
DSMES is a reimbursable benefit by Medicaid, Medicare, and private payers. The typical benefit for DSMES is 1 hour of individual and 9 hours of group education within the 1st year of a diabetes diagnosis, and 2 hours of DSMES each year after (this may vary by private payers).
There are two accrediting organizations recognized by the Centers for Medicare and Medicaid Services (CMS). Colorado Medicaid follows the CMS policy of requiring accreditation from one of these programs.
To promote quality education for people with diabetes, both the American Diabetes Association (ADA) and the Association of Diabetes Care and Education Specialists (ADCES) endorse the 2017 National Standards for Diabetes Self-Management Education and Support.
At least one of the team members responsible for facilitating DSMES services must be ONE of the following:
Registered Nurse (RN)
Registered Dietitian/Nutritionist (RD/RDN)
Pharmacist with training and experience pertinent to DSMES (PharmD)
Healthcare professional holding certification as a Diabetes Care and Education Specialists (CDCES) or a Board Certification in Advanced Diabetes Management (BC-ADM)
Note: Other healthcare workers or diabetes paraprofessionals may contribute to DSMES services with appropriate training in DSMES and with supervision and support by at least one of the team members listed above.
For more information on staff requirements and continuing education requirements for your DSMES team click here.
The following are examples of existing curriculum that meet Standard 6 of the National Standards for DSMES. Note: this is not a comprehensive list.
*this curriculum was developed from the ADCES curriculum linked above
DSMES services provided via telehealth allow participants to receive the same benefits as in-person visits along with the added convenience of video conferencing, phone calls or texting in order to receive the critical care they need.
See the guides below to learn more about how to implement telehealth services in your organization:
- Medicare Coverage for Telehealth
Medicare covers individual and group DSMT* and MNT telehealth sessions when: 1) injection training is not required 2) Medicare beneficiaries reside in rural health professional shortage areas
*CMS uses the term “training” (DSMT) instead of “education and support” (DSMES) when defining the reimbursable Medicare billing benefit.
More information on the CMS benefit policy for telehealth can be found here, beginning on page 147: Medicare Claims Processing Manual
Note: Due to the COVID-19 Public Health Emergency, Medicare has introduced some temporary flexibilities to telehealth services. Refer to pages 87-89 of this document:
- Medicaid Coverage for Telehealth
DSMES via telehealth is a Colorado Medicaid covered benefit.
Non-physician providers are now authorized to provide health education services (the provision of counseling, referral, instruction, suggestions, and support to maintain or improve health) under general supervision of a provider; direct supervision is no longer required as long as the supervising provider is immediately available via audio/visual or audio.
More information can be found here: Colorado Dept of Health Care Policy and Financing
The typical benefit for DSMES is 1 hour of individual and 9 hours of group education within the 1st year of a diabetes diagnosis, and 2 hours of DSMES (individual or group) each year after (this may vary by private payers).
Let Colorado Medicaid know of your accreditation/recognition status here to begin billing for your services.
Centers for Medicare and Medicaid Services (CMS)
*Note CMS uses the term “training” (DSMT) instead of “education and support” (DSMES) when defining the reimbursable Medicare billing benefit.
Click here for additional CMS billing and payment guidelines.
Click here to access Novitas Solutions website, Colorado’s Medicare Administrative Contractor (MAC).
We recommend contacting private payers directly, as coverage varies.
Medical Nutrition Therapy (MNT)
MNT is defined as a “nutrition-based treatment provided by a registered dietitian nutritionist” (DSMES Toolkit: MNT). The MNT benefit is a completely separate, yet complementary, benefit from Diabetes Self-Management Training (DSMT). MNT can reduce A1C by up to 2%, making it an essential component of initial and ongoing diabetes care. In fact, studies have shown that DSMT and MNT are more effective together than either service would be if offered alone. Note: Medicare will not reimburse DSMT and MNT if provided on the same day.
For more information, go to the MNT section of the Academy of Nutrition and Dietetics website here: Medical Nutrition Therapy
Best Practice Resources
Participant Education Resources
Marketing and outreach is vital to DSMES sustainability. The following tools and resources have been created to help you better engage providers and connect with future participants!
- Healthcare Provider-facing Materials
- Tools for DSMES Educators
- Social Media Campaign Materials
Join the DSMES monthly utilization calls
Are you in need of additional support? Or would you just like to connect with other DSMES providers in your state? Whether your program is brand new or has been around for years, our monthly sharing calls, facilitated by CDPHE, exist to support you! The calls take place every third Wednesday of the month.
With low utilization of DSMES services amongst Coloradans affected by diabetes, the primary purpose of the calls is to provide an opportunity for partners to discuss barriers to DSMES utilization, share successes, and identify tools that may be helpful in increasing participation in DSMES services throughout the state.
Click here to subscribe to our DSMES email list and you will receive information and invites to our monthly calls, every third Wednesday of the month.
While evidence-based programs can decrease the burden of diabetes, in 2017 only 59.4% of Colorado adults with diabetes reported having ever taken a diabetes self-management class.
For further guidance, contact Lisa Bentley, Diabetes Management Coordinator at CDPHE: email@example.com
Association of Diabetes Care and Education Specialists (ADCES) : firstname.lastname@example.org 800.338.3633
American Diabetes Association (ADA): email@example.com 1.800.DIABETES (342.2383)
Colorado Medicaid Claims and Billing Questions: 1.844.235.2387