CMS Diabetes Outpatient Self-Management Training Coverage Policy Update (NCD 251)

CMS has issued a modification to National Coverage Determination (NCD) 251, which governs Medicare coverage for Diabetes Outpatient Self-Management Training (DSMT). This update—effective March 12, 2026—signals billing teams should revisit their documentation workflows, eligibility verification processes, and compliance with the regulatory conditions outlined in 42 CFR 410.140–410.146. If your practice bills Medicare for diabetes self-management education services, this policy is directly in scope.

What Is CMS NCD 251? Understanding the Medicare DSMT Benefit

The Centers for Medicare & Medicaid Services established NCD 251 to define Medicare's coverage policy for Diabetes Outpatient Self-Management Training. DSMT is a structured program that equips patients diagnosed with diabetes with the skills and knowledge to manage their condition—covering topics like blood glucose monitoring, nutrition, medication adherence, and complication prevention.

Medicare has long recognized DSMT as a covered benefit under Part B, but coverage is conditional. It isn't enough that a patient has a diabetes diagnosis. The program, the provider, and the referral all have to meet specific regulatory requirements before CMS will pay.

The core regulatory authority for this benefit lives in 42 CFR 410.140 through 410.146. Those sections define who can receive DSMT, who can furnish it, what the program must include, and how much Medicare will cover annually. This March 2026 modification to NCD 251 makes it more important than ever that billing teams are working from the current version of those requirements.

Medicare Coverage Conditions for DSMT Under 42 CFR 410.140–410.146

CMS's NCD 251 directly references 42 CFR 410.140–410.146 as the governing framework for coverage. The specific conditions required for Medicare payment include several distinct components your team must understand.

Patient Eligibility
The beneficiary must have a diagnosis of diabetes (Type 1, Type 2, or gestational). DSMT is a Part B benefit, so the patient must be enrolled in Medicare Part B. The treating physician or qualified non-physician practitioner must certify that DSMT is medically necessary.

Program Accreditation Requirements
The DSMT program itself must be accredited by a CMS-recognized accreditation organization—currently the American Diabetes Association (ADA) or the Association of Diabetes Care & Education Specialists (ADCES). Claims submitted for services provided by non-accredited programs will not be covered under Medicare.

Hour Limitations
Medicare limits DSMT coverage as follows under the CFR framework:

• Up to 10 hours of initial DSMT (including one hour of individual assessment) in the first calendar year
• Up to 2 hours of follow-up DSMT in each subsequent year

Documentation must support the medical necessity for each session billed, and the total hours billed cannot exceed these annual caps.

Referral and Ordering Requirements
A physician or qualified non-physician practitioner must refer the patient to DSMT. That referral is a hard requirement for Medicare coverage—self-referred or standing-order situations without active physician involvement are billing red flags.

Group vs. Individual Training
DSMT can be furnished in group settings (two or more beneficiaries at a time) or individually. Individual training is only covered when group training is not available or is medically inappropriate for the patient. Documentation supporting the need for individual training should be in the medical record if that's how the service is billed.

Affected Codes

The updated NCD 251 policy document does not list specific CPT or HCPCS codes within the policy data at this time. Billing teams should reference the associated claims processing transmittals—particularly TN AB-02-151, TN B-02-062, and TN A-02-032—for the applicable billing codes and instructions.

Historically, DSMT services have been billed using the following HCPCS codes, which CMS has used for this benefit category. Confirm these against current transmittals before billing, as this policy modification may affect coding guidance:

No codes are enumerated in the current NCD 251 policy data. Do not rely on codes from prior versions of this policy without verifying against the current transmittals linked by CMS.

Claims Processing Transmittals: What to Review

One of the most operationally important aspects of NCD 251 is the set of claims processing transmittals CMS has cross-referenced. These documents contain the billing instructions that translate the coverage policy into actual claim submission requirements. The transmittals cited in this policy include:

• TN AB-02-151 — Program Memorandum Intermediaries/Carriers
• TN B-02-062 — Program Memorandum Carriers
• TN A-02-032 — Program Memorandum Intermediaries
• TN AB-01-109 — Program Memorandum Intermediaries/Carriers
• TN B-01-40 — Program Memorandum Carriers
• TN AB-00-66 — Program Memorandum Intermediaries/Carriers
• TN 13 — Medicare Benefit Policy Manual
• TN 305 — Medicare Home Health Agency Manual
• TN 1895 — Medicare Intermediary Manual

Your billing and compliance team should pull the most current CMS guidance alongside these transmittals. The Benefit Policy Manual (TN 13) in particular is a key resource for understanding what Medicare will and won't cover in this benefit category.

What Your Billing Team Should Do