Physicians may claim for providing diabetes education services to individual or groups of patients with diabetes under Tariffs 8575 Insulin Pump Instruction (individual) and 8576 Diabetes self-care group teaching session. These tariffs are both payable on a time basis, at a rate of $26.35 per fifteen minute period. (See below for full tariff descriptions and billing notes).
Tariff 8575 -Insulin Pump Instruction (individual)
In order to claim this tariff, the diabetes education provided must be specifically regarding insulin pump instruction. More general instruction and discussion on the use of diabetic devices (e.g., home glucose monitors, insulin pens etc.,) diet, warning signs or symptoms is only insured when it is part of a diabetes self-care group teaching sessions.
Physicians may choose to refer their patients requiring individual diabetes education to the appropriate Diabetes and Chronic Disease Self-Management Education Program. (see).
Tariff 8576 – Diabetes self-care group teaching session
In order to claim this tariff, physicians must provide education to a group of individuals. A “group” must consists of two or more individuals, each withdiagnosed diabetes, or one patient with diagnosed diabetes, who is accompanied by a family member(s) or other caregiver(s).
This education may consist of general instruction on the use of diabetic devices (e.g., home glucose monitors, insulin pens etc.,) and/or education and discussion related to diet, warning signs or symptoms, etc.
8575 Insulin pump instruction (individual) per fifteen (15) minute period $26.90
8576 Diabetes self-care group teaching session per fifteen (15) minute period $26.90
- The total fee for the group teaching session must be divided by the number of patients with diabetes in the group and billed for each patient on a separate claim.
- Tariff rate is payable for the first full fifteen (15) minute period and for each additional fifteen (15) minute period or major portion thereof.
- Tariff rate is payable per group teaching session, regardless of the number of individuals present in the group.
- The claim must include the time the teaching session took place and the names of all patients and family members/caregivers in attendance.
- .A claim may be made for another service, including a visit, provided on the same day as the diabetes self-care group teaching session, so long as such other service is provided either prior to, or following, the period of time covered by the teaching session.
- For both Tariff 8575 and 8576: A minimum of fifteen minutes of diabetes education must be provided to be eligible to claim these tariffs. When an education session precedes or follows an examination of the patient, although it is not required, it is recommended that the start and end time of both the examination and the teaching session be indicated on the chart.
Updated: April 2018