Beneficiaries Eligible for Coverage and Definition of Diabetes

Medicare Part B covers 10 hours of initial training for a beneficiary who has been diagnosed with diabetes.
Diabetes is diabetes mellitus, a condition of abnormal glucose metabolism diagnosed using the following criteria;

• a fasting blood sugar greater than or equal to 126 mg/dL on two different occasions;

• a 2 hour post-glucose challenge greater than or equal to 200 mg/dL on 2 different occasions; or

o a random glucose test over 200 mg/dL for a person with symptoms of uncontrolled diabetes.

Documentation that the beneficiary is diabetic is maintained in the beneficiary’s medical record.

Beneficiaries are eligible to receive follow-up training each calendar year following the year in which they have been certified as requiring initial training or they may receive follow-up training when ordered even if Medicare does not have documentation that initial training has been received. In that instance, contractors shall not deny the follow-up service even though there is no initial training recorded.