QUEST Integration – Diabetes Education

Original Effective Date:

10/01/2006

Current Effective Date:

01/01/2015

For Contracted Diabetes Management Providers (CMP)

The HMSA Plan for QUEST Integration Members includes benefits for diabetes education for participants in HMSA’s diabetes management services when the services are performed by contracted providers.

Administrative Requirements

Environmental

Providers must furnish services in settings that are conducive to adult learning. Each setting should:

1. Have adequate lighting, ventilation, and minimal ambient noise level.
2. Be ADA-accessible and reasonably convenient for HMSA members.
3. Comfortably accommodate a minimum of three attendees.

Claims Filing

General Directions

Hard-copy claims must be filed using the CMS 1500 claim form. Comprehensive directions for completing the CMS 1500 form can be found in the claims filing information section.

Providers who file using electronic medical claims (EMC) should file claims in accordance with the data requirements specified by their vendors.

A. Referring Physician

If the patient has contacted you as a result of a self-referral or referral through either HMSA’s disease management services or HMSA staff, please contact the physician who is monitoring and treating the patient for diabetes. To ensure continuity of care, the physician should be informed of the patient’s wish to attend classes and of the patient’s progress. If the physician has been contacted, the physician’s name may be entered as the referring or ordering physician.

B. Procedure Codes

You may use one or more of the following HCPCS codes as appropriate.

Note: Providers are asked to provide one hour of training per session. Therefore, when using HCPCS codes G0108 or G0109 to bill for a one-hour training session, the number “2” should be placed in the days or units column (24G) of the CMS 1500 claim form.

For more information, please visit the Diabetes Education information page.

Revision History