Applies to members of:
A disease in which the body produces too little or no insulin, or insulin is produced but the body can't use it. This results in high levels of sugar in the blood.
Diabetes clinical practice guideline
Medicare authorizations for diabetes testing supplies
To prescribe more than the approved limit of diabetes testing supplies for Medicare Advantage plan members, a Pre-Service Organization Determination (PSOD) is required. A PSOD is equivalent to the Advance Beneficiary Notice (ABN) used by Original Medicare, but under Part C Medicare rules it must be issued by Priority Health.
The provider should document if a member is not insulin dependent.
Diabetes management patient training
No authorization is required for payment to participating providers for diabetes education. PCP referral is encouraged.
Codes covered for all products in outpatient facility and physician office locations:
- G0108, Diabetes outpatient self-management training services, individual, per 30 minutes
- G0109, Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
- Facilities billing on a UB04, use revenue code 0942 in combination with the CPT/HCPCS codes.
Nutrition counseling provided by a dietitian during diabetes training can be billed separately for members of most plans.
Pays at the full medical benefit.
Self-funded plans may require a copay or coinsurance instead of paying the full amount. Call the Provider Helpline to verify.
The deductible applies for HSA members.
Coordination of care
Our Behavioral Health department has clinical staff available who specialize in helping members manage complex and chronic mental health and substance use conditions.
Approved drug list
View coverage details for medications that are covered under the pharmacy benefit.
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