Georgia Medicare DSMT and MNT Coverage

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Georgia Medicare Diabetes Self-Management Training and Medical Nutrition Therapy

By Brevy Care Team · Last verified May 13, 2026

Section 1861(qq) of the Social Security Act, added by Section 4105 of the Balanced Budget Act of 1997, establishes the Diabetes Self-Management Training (DSMT) benefit. Section 1861(vv), added by Section 105 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA 2000), establishes the Medical Nutrition Therapy (MNT) benefit. The implementing regulations at 42 CFR 410.140 through 410.146 (DSMT) and 42 CFR 410.130 through 410.134 (MNT) specify the conditions of coverage, the provider requirements, the hour limits, and the accreditation standards. DSMT covers 10 hours of initial training in the first 12 months after a physician order plus 2 hours of follow-up training each subsequent year. Programs must be accredited by the American Diabetes Association (ADA) or the Association of Diabetes Care and Education Specialists (ADCES, formerly American Association of Diabetes Educators/AADE). MNT covers 3 hours of initial therapy in the first year and 2 hours in subsequent years, limited to diabetes, chronic kidney disease (non-dialysis), and post-kidney-transplant patients. MNT must be furnished by a Registered Dietitian or qualified nutrition professional meeting 42 CFR 410.134. The Medicare Diabetes Prevention Program (MDPP), authorized by Section 4108 of the Affordable Care Act and expanded by the CMS Innovation Center using Section 1115A(c) authority effective April 1, 2018, provides a structured 12-month lifestyle change program for Medicare beneficiaries with prediabetes, modeled on the CDC's National Diabetes Prevention Program. The MDPP has NO beneficiary cost-sharing, a unique feature among Part B services. This guide explains how every layer of the framework operates, the Georgia DSMT/MNT/MDPP provider landscape, and how Georgia Medicare beneficiaries with diabetes or prediabetes access these education and counseling services. :::

::: callout Key Takeaways

1. Section 1861(qq) of the Social Security Act, added by BBA 1997 Section 4105, covers Diabetes Self-Management Training (DSMT). Implementing regulation at 42 CFR 410.140 through 410.146.
2. Section 1861(vv), added by BIPA 2000 Section 105, covers Medical Nutrition Therapy (MNT). Implementing regulation at 42 CFR 410.130 through 410.134.
3. DSMT coverage: 10 hours of initial training in the first 12 months after physician order (1 hour individual + 9 hours group), plus 2 hours of follow-up training each subsequent 12-month period. Must be furnished by a program accredited by ADA Education Recognition Program or ADCES (formerly AADE).
4. MNT coverage: 3 hours of initial therapy in the first calendar year, 2 hours in each subsequent year. Covers diabetes, chronic kidney disease (non-dialysis), and post-kidney-transplant patients. Must be furnished by a Registered Dietitian or qualified nutrition professional meeting 42 CFR 410.134.
5. The Medicare Diabetes Prevention Program (MDPP), authorized by ACA Section 4108 and expanded by the CMS Innovation Center using Section 1115A(c) authority effective April 1, 2018, provides a 12-month structured lifestyle program for beneficiaries with prediabetes.
6. MDPP coverage criteria: HbA1c 5.7-6.4 percent, fasting plasma glucose 110-125 mg/dL, or 2-hour OGTT 140-199 mg/dL within 12 months; BMI ≥ 25 (or ≥ 23 for Asian beneficiaries); no previous diabetes diagnosis (other than gestational); no ESRD on dialysis.
7. Cost-sharing: DSMT and MNT have 20 percent Part B coinsurance after deductible. MDPP has NO beneficiary cost-sharing, a unique feature among Part B services designed to maximize uptake.
8. Georgia diabetes prevalence (12-13 percent of adults) exceeds the national average. Major DSMT/MNT programs at Emory, Piedmont, Wellstar, NGHS, Memorial Health, AU/Wellstar MCG, Phoebe, Grady, Atrium Navicent, and Tanner. MDPP suppliers include YMCAs (in-person) and virtual platforms (Lark Health, Omada Health, Health Catalyst, others). :::

Why Diabetes Education and Nutrition Matter for Medicare Beneficiaries

Diabetes is the seventh leading cause of death in the United States and the leading cause of kidney failure, lower-limb amputation, and adult-onset blindness. Medicare beneficiaries have a diabetes prevalence rate exceeding 25 percent. In Georgia, diabetes prevalence among adults exceeds the national average (approximately 12 to 13 percent), with the highest rates in rural southwest and middle Georgia counties reflecting demographic and socioeconomic patterns.

Evidence-based interventions like DSMT, MNT, and MDPP reduce HbA1c, prevent or delay complications, lower hospitalization rates, and improve quality of life. The Centers for Disease Control and Prevention has demonstrated that the National Diabetes Prevention Program reduces incident type 2 diabetes by approximately 58 percent over three years in participants who achieve modest weight loss (5 to 7 percent of body weight). Medicare's coverage framework for diabetes education and prevention reflects this evidence and aims to make these interventions accessible to every eligible beneficiary.

The Statutory and Regulatory Architecture

Section 1861(qq): Diabetes Self-Management Training

Section 1861(qq) of the Social Security Act, added by Section 4105 of the Balanced Budget Act of 1997 (Public Law 105-33), establishes DSMT as a covered Medicare benefit effective January 1, 1998. The statute describes DSMT as "training" rather than "treatment," reflecting the educational nature of the service. DSMT is delivered by certified providers (typically hospital-affiliated diabetes education programs, physician offices with embedded diabetes educators, or federally qualified health centers) that have been accredited by an organization recognized by CMS.

Section 1861(vv): Medical Nutrition Therapy

Section 1861(vv), added by Section 105 of BIPA 2000 (Public Law 106-554), establishes MNT as a covered Medicare benefit effective January 1, 2002. The original MNT benefit covered only diabetes and renal disease. The benefit has been administratively refined but remains substantially narrower than DSMT in terms of qualifying conditions. As of 2026, MNT covers:

• Diabetes (Type 1, Type 2)
• Chronic kidney disease (CKD) not on dialysis
• Post-kidney-transplant beneficiaries within 36 months of transplant

MNT is delivered by Registered Dietitians or qualified nutrition professionals meeting the provider qualifications at 42 CFR 410.134.

42 CFR 410.140 through 410.146: DSMT Conditions of Coverage

The implementing regulation at 42 CFR 410.140 through 410.146 specifies the coverage conditions:

Definitions (42 CFR 410.140):

• DSMT is a program that teaches diabetes self-care behaviors to assist beneficiaries with self-management
• A certified provider is a physician or other individual provider of diabetes services accredited by a CMS-recognized accreditation organization

Conditions of Coverage (42 CFR 410.141): DSMT is covered when:

• The beneficiary has diabetes (Type 1, Type 2, or gestational)
• A physician (or qualified non-physician practitioner) managing the beneficiary's diabetic condition orders the training and certifies it is needed
• The training is furnished by a certified provider meeting quality standards
• The training meets criteria for content, duration, and delivery

Hours of Coverage (42 CFR 410.142):

• Up to 10 hours of initial training in the first 12 months after the physician order: 1 hour of individual training plus up to 9 hours of group training
• Up to 2 hours of follow-up training each subsequent 12-month period
• Individual training (beyond the initial 1 hour) is covered when group classes are unavailable within 2 months, when the physician documents specific medical conditions warranting individual training, or when the beneficiary needs additional training after group sessions

Group Training (42 CFR 410.143):

• 2 to 20 beneficiaries per group
• May include family members or caregivers

Quality Standards (42 CFR 410.144): DSMT programs must be accredited by a CMS-approved accreditation organization. As of 2026, two organizations are CMS-approved:

• American Diabetes Association (ADA) Education Recognition Program
• Association of Diabetes Care and Education Specialists (ADCES, formerly American Association of Diabetes Educators/AADE)

The accrediting standards require that the DSMT program meet the National Standards for Diabetes Self-Management Education and Support, published jointly by ADA and ADCES and updated periodically (current standards reflect the 2022 update).

42 CFR 410.130 through 410.134: MNT Conditions of Coverage

Definitions (42 CFR 410.130):

• MNT is nutritional diagnostic, therapeutic, and counseling services for the purpose of disease management
• A Registered Dietitian (RD) or Nutrition Professional must meet the qualifications at 42 CFR 410.134

Conditions of Coverage and Hours (42 CFR 410.132): MNT is covered when:

• The beneficiary has diabetes, CKD not on dialysis, or had a kidney transplant within the past 36 months
• A physician refers the beneficiary
• The MNT is furnished by a Registered Dietitian or qualified nutrition professional

Hour limits:

• 3 hours of MNT in the first calendar year of treatment
• 2 hours of MNT each subsequent calendar year
• Additional hours may be covered when the treating physician documents a change in the beneficiary's condition warranting additional MNT

Provider Qualifications (42 CFR 410.134): A Registered Dietitian or nutrition professional must:

• Hold a bachelor's or higher degree in nutrition or dietetics from an accredited program
• Have completed at least 900 hours of supervised practice experience or a Commission on Dietetic Registration-accredited internship
• Be licensed or certified by the state where the services are furnished (Georgia licenses dietitians under the Georgia Board of Examiners of Licensed Dietitians)

42 CFR 410.79: Medicare Diabetes Prevention Program

The Medicare Diabetes Prevention Program (MDPP) is a structured intervention modeled on the CDC's National Diabetes Prevention Program. The MDPP was originally tested as a CMS Innovation Center demonstration under ACA Section 4108 authority. CMS expanded MDPP to a covered Medicare benefit using CMMI expansion authority at Section 1115A(c) of the Social Security Act through the CY 2017 Physician Fee Schedule Final Rule, effective April 1, 2018.

Coverage Criteria:

• HbA1c 5.7-6.4 percent, fasting plasma glucose 110-125 mg/dL, or 2-hour plasma glucose 140-199 mg/dL during OGTT within the 12 months preceding the first MDPP core session
• BMI ≥ 25 (BMI ≥ 23 for self-identified Asian beneficiaries)
• No previous diagnosis of diabetes (other than gestational diabetes)
• No ESRD on dialysis

Structure:

• 16 weekly core sessions in the first 6 months (months 1 through 6)
• 6 monthly core sessions in the second 6 months (months 7 through 12)
• Optional ongoing maintenance: 12 monthly sessions in year 2 if the beneficiary achieves and maintains a weight-loss goal

Payment:

• Performance-based payment to MDPP suppliers tied to attendance and weight-loss outcomes
• NO beneficiary cost-sharing under MDPP (unique among Part B services)
• Payment per beneficiary ranges from approximately $50 to over $700 over the 24-month program depending on attendance and weight loss

Suppliers: MDPP suppliers must be CMS-recognized and may be in-person providers (YMCAs, hospital-affiliated programs, community organizations) or virtual/digital health platforms. CMS-recognized virtual MDPP suppliers as of 2026 include Lark Health, Omada Health, Health Catalyst, and others.

Establishing Authorities and Legislative History

BBA 1997 Section 4105: DSMT Establishment

Section 4105 of the Balanced Budget Act of 1997, signed August 5, 1997, added Section 1861(qq) to the Social Security Act and directed the Secretary of HHS to establish quality standards for accredited DSMT programs. The benefit became effective January 1, 1998. Before BBA 1997, diabetes education was furnished sporadically and inconsistently, often bundled into physician E/M services with no separate payment.

BIPA 2000 Section 105: MNT Establishment

Section 105 of BIPA 2000 (Public Law 106-554), signed December 21, 2000, added Section 1861(vv) to the Social Security Act, establishing Medical Nutrition Therapy as a Medicare-covered service for diabetes and renal disease, effective January 1, 2002. The original MNT benefit was limited to these two conditions and has not been substantially expanded by statute since.

ACA Section 4108: MDPP Demonstration

Section 4108 of the Affordable Care Act (Public Law 111-148), signed March 23, 2010, authorized the CMMI Diabetes Prevention Program demonstration. CMMI tested the model from 2013 through 2016 and demonstrated reductions in weight, HbA1c, and progression to diabetes.

CMS Innovation Center Expansion of MDPP: April 2018

Through the CY 2017 Physician Fee Schedule Final Rule (published November 2016), CMS used the Section 1115A(c) expansion authority to expand MDPP from a CMMI demonstration to a Medicare-covered benefit. The expanded benefit became effective April 1, 2018.

DSMT and MNT Procedure Codes

DSMT Codes

Approximate payment: $50 to $75 per 30-minute unit, varying by setting and locality.

MNT Codes

Approximate payment: $35 to $45 per 15-minute unit, varying by setting.

MDPP Codes (HCPCS G-codes)

Additional codes through G9890 cover various attendance and weight-loss milestones across the 24-month program. Each milestone triggers a performance-based payment to the MDPP supplier.

Beneficiary Cost-Sharing

DSMT: 20 percent Part B coinsurance after annual Part B deductible ($278 in 2026). Medicare Supplement Plans G and N typically cover the coinsurance.

MNT: 20 percent Part B coinsurance after annual deductible. Under the ACA preventive services framework, MNT in certain preventive contexts may be cost-shared at 0 percent; this is rare and depends on specific coding and documentation.

MDPP: NO beneficiary cost-sharing. The MDPP is unique among Part B services in that the beneficiary owes nothing for MDPP services. This was a deliberate design choice to maximize uptake among the prediabetes population.

Telehealth Coverage

Both DSMT and MNT may be furnished via telehealth under the Medicare telehealth framework (Section 1834(m)). Originally, DSMT was furnished only in person. The COVID-19 public health emergency expanded telehealth coverage to include DSMT and MNT. The CAA 2022 (Public Law 117-103) extended COVID telehealth flexibilities through December 2024, and the CAA 2023 (Public Law 117-328) further extended through December 2024. Subsequent legislation has continued the extension. As of 2026, DSMT and MNT may be furnished via telehealth in approved circumstances.

The Medicare Diabetes Prevention Program has long included digital and virtual delivery options. CMS-recognized virtual MDPP suppliers serve Georgia beneficiaries statewide regardless of geographic distance from in-person providers.

Georgia DSMT and MNT Landscape

Major Hospital-Based DSMT and MNT Programs

Emory Healthcare Diabetes Education Program (ADA accredited) operates at multiple Emory hospital sites in metro Atlanta. The Emory Diabetes Education Program is one of the largest in the Southeast and provides both DSMT and MNT services.

Piedmont Diabetes Resource Centers (ADCES accredited) operate at Piedmont Atlanta, Piedmont Fayette, Piedmont Henry, Piedmont Newnan, Piedmont Columbus, Piedmont Macon, and Piedmont Athens Regional. Each center provides DSMT, MNT, and integrated diabetes management.

Wellstar Diabetes Education Program operates at Wellstar Kennestone, Wellstar North Fulton, Wellstar Cobb, Wellstar Spalding Regional, and Wellstar West Georgia.

Northeast Georgia Health System Diabetes Education operates at NGMC Gainesville and NGMC Braselton.

Memorial Health Diabetes Education Center (Savannah) provides DSMT and MNT for southeast Georgia beneficiaries.

AU Health / Wellstar MCG Diabetes Education Program in Augusta provides services for east-central Georgia beneficiaries and serves as a referral center for complex cases.

Phoebe Diabetes Education Center in Albany serves southwest Georgia, an area with particularly high diabetes prevalence.

Grady Diabetes Clinic and Education Program at Grady Memorial Hospital in Atlanta serves the safety-net population.

Atrium Health Navicent Diabetes Education Program in Macon serves middle Georgia.

Tanner Diabetes Education at Tanner Medical Center Carrollton serves west Georgia.

Independent and Specialty DSMT Programs

Multi-physician endocrinology practices including Atlanta Diabetes Associates, Diabetes and Endocrine Associates, and Northside Hospital Diabetes Services operate embedded DSMT programs with ADA or ADCES accreditation.

Medicare Diabetes Prevention Program Suppliers in Georgia

In-person MDPP suppliers:

• YMCA of Metro Atlanta (multiple branches)
• YMCA of Coastal Georgia (Savannah area)
• Selected hospital-affiliated programs

Virtual/digital MDPP suppliers serving Georgia beneficiaries:

• Lark Health
• Omada Health
• Health Catalyst
• Other CMS-recognized digital suppliers

Virtual MDPP delivery is particularly valuable for rural Georgia beneficiaries who do not have a local in-person MDPP supplier within reasonable travel distance.

Registered Dietitian Practice in Georgia

The Georgia Board of Examiners of Licensed Dietitians licenses Registered Dietitians in Georgia. The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is the professional organization. RDs work in hospital diabetes education centers, freestanding clinics, physician offices, and private practice. Independent RD practices accept Medicare for MNT services through enrollment with Palmetto GBA Jurisdiction J.

Georgia DPH Diabetes Prevention and Control Program

The Georgia Department of Public Health Diabetes Prevention and Control Program operates statewide initiatives to reduce diabetes prevalence, improve diabetes care, and support DSMT and MDPP delivery, particularly in underserved rural communities. The program offers technical assistance to hospitals and community organizations seeking ADA or ADCES accreditation and supports MDPP supplier recognition.

Rural Access

Rural Georgia diabetes prevalence (12-13 percent of adults) substantially exceeds the national average. Rural access to in-person DSMT and MNT is limited by the geographic distribution of accredited programs. Telehealth delivery of DSMT and MNT, expanded during the COVID public health emergency and extended by subsequent legislation, has improved rural access. Virtual MDPP suppliers further support rural beneficiaries with prediabetes who would not otherwise have access to a structured prevention program.

Worked Examples

Example 1: Margaret, 78, Atlanta, Newly Diagnosed Type 2 Diabetes 10-Hour DSMT at Emory Diabetes Education

Margaret is diagnosed with type 2 diabetes during a routine physical with her primary care physician at Emory Internal Medicine. Her PCP refers her for DSMT and prescribes metformin. The PCP orders 10 hours of DSMT at the Emory Diabetes Education Program, an ADA-accredited program.

DSMT structure:

• 1 hour of individual training (initial assessment, individualized goal-setting)
• 9 hours of group training across multiple sessions (typically 2-hour weekly group classes)
• Topics covered: diabetes pathophysiology, medication management, blood glucose monitoring, nutrition, physical activity, foot care, illness management, psychosocial support

Billing:

• G0108 (individual, 2 units of 30 min): approximately $50 × 2 = $100
• G0109 (group, 18 units of 30 min): approximately $50 × 18 = $900
• Total DSMT billing: approximately $1,000

Beneficiary cost-sharing:

• 20 percent coinsurance: $200
• Margaret has Plan G, which covers the coinsurance
• Margaret's out-of-pocket for DSMT: $0

Example 2: Robert, 82, Savannah, Uncontrolled Type 2 Diabetes HbA1c 9.4, 3-Hour MNT at Memorial Health

Robert has type 2 diabetes with poor glycemic control (HbA1c 9.4 percent). His endocrinologist refers him for Medical Nutrition Therapy. Robert sees a Registered Dietitian at the Memorial Health Diabetes Education Center over multiple visits totaling 3 hours.

MNT structure:

• Initial assessment and intervention: 1 hour (CPT 97802, 4 units of 15 min)
• Follow-up visits: 2 hours over 4 visits (CPT 97803, 8 units of 15 min)

Billing:

• CPT 97802, 4 units: approximately $40 × 4 = $160
• CPT 97803, 8 units: approximately $40 × 8 = $320
• Total MNT billing: approximately $480

Beneficiary cost-sharing:

• 20 percent coinsurance: $96
• Robert has no Medigap
• Robert's out-of-pocket for MNT: $96

Example 3: Linda, 75, Macon, Prediabetes HbA1c 6.0, YMCA Medicare Diabetes Prevention Program

Linda has prediabetes (HbA1c 6.0 percent on her recent annual wellness visit) and a BMI of 28. Her PCP refers her to the YMCA of Coastal Georgia's MDPP location, a CMS-recognized in-person MDPP supplier serving the Macon area.

MDPP structure:

• 16 weekly core sessions in the first 6 months
• 6 monthly core sessions in months 7 through 12
• Optional 12 ongoing maintenance sessions in year 2 if Linda achieves and maintains 5 percent weight loss

Billing:

• Performance-based payment to the YMCA supplier
• G9873 (first session): approximately $30
• G9874 (4 sessions): approximately $30
• G9875 (9 sessions): approximately $60
• G9876 (9 sessions + 5 percent weight loss): approximately $120
• Continued performance-based payments through 24 months
• Total supplier payment ranges from $0 (if no sessions attended) to over $700 (if all sessions plus sustained weight loss achieved)

Beneficiary cost-sharing:

• $0 cost-sharing under MDPP (unique among Part B services)
• Linda's out-of-pocket: $0

This example illustrates the unique no-cost-sharing structure of MDPP, intentionally designed to remove financial barriers to enrollment for the prediabetes population.

Example 4: Charles, 80, Augusta, Type 2 Diabetes with Stage 3 CKD, Dual DSMT and MNT (CKD Indication)

Charles has type 2 diabetes and stage 3 chronic kidney disease (eGFR 45 mL/min/1.73m²). His PCP refers him for both DSMT (for diabetes management) and MNT (for both diabetes and CKD non-dialysis indication). Charles receives services at the AU Health Diabetes Education Program and AU Health Renal Nutrition Clinic in Augusta. Charles has Original Medicare with Plan G.

DSMT (10 hours initial): approximately $1,000 total billing MNT (3 hours initial, dual indication): approximately $480 total billing Total billing: approximately $1,480

Beneficiary cost-sharing:

• 20 percent coinsurance: $296
• Plan G covers the coinsurance
• Charles's out-of-pocket: $0

Note: MNT coverage for CKD non-dialysis was added to the original MNT benefit under Section 1861(vv) and 42 CFR 410.132. Charles qualifies for MNT under both the diabetes indication and the CKD indication. CMS does not double-count the hours; the 3-hour initial and 2-hour subsequent limits apply to the beneficiary, not to each qualifying condition separately.

Example 5: Patricia, 73, Columbus, Type 1 Diabetes 2-Hour Annual DSMT Refresher at Piedmont Columbus

Patricia has long-standing type 1 diabetes diagnosed in childhood. She has been on Medicare for 8 years. Each year, her endocrinologist orders the 2-hour annual DSMT refresher to update her knowledge of changing diabetes technology (continuous glucose monitor adjustments, insulin pump updates, new pharmacotherapy options) and to review her self-management practices. Patricia attends a 2-hour group session at the Piedmont Columbus Diabetes Resource Center. Patricia has Original Medicare with Plan N.

Billing:

• G0109 (group, 4 units of 30 min): approximately $50 × 4 = $200

Beneficiary cost-sharing:

• 20 percent coinsurance: $40
• Plan N covers the coinsurance (DSMT is not an office E/M visit, so the $20 office copay does not apply)
• Patricia's out-of-pocket: $0

Example 6: Henry, 85, Rural Bainbridge, Type 2 Diabetes, Telehealth DSMT Under Extended Telehealth Flexibilities

Henry lives in Bainbridge in rural southwest Georgia. The closest accredited DSMT program is in Albany, more than 60 miles away. Under the extended COVID telehealth flexibilities (CAA 2022, CAA 2023, and subsequent legislative extensions), Henry attends DSMT virtually from his home via video conferencing with the Phoebe Diabetes Education Center in Albany.

DSMT structure: Same 10-hour initial plus 2-hour annual structure, delivered via telehealth

Billing: Same G0108 and G0109 codes, with appropriate telehealth modifiers

Beneficiary cost-sharing:

• 20 percent coinsurance as in-person DSMT
• Henry has Plan G, which covers the coinsurance
• Henry's out-of-pocket: $0
• Travel savings: substantial (no 120-plus-mile round trip per session)

This example illustrates how telehealth extensions enable rural Medicare beneficiaries to access DSMT and MNT services that would otherwise be inaccessible due to travel distance.

Common Mistakes and Pitfalls

1. Confusing DSMT with MNT

DSMT is diabetes self-management training, an educational program for diabetes self-care behaviors. MNT is medical nutrition therapy, one-on-one or group nutrition counseling for diabetes, CKD non-dialysis, and post-kidney-transplant patients. DSMT focuses on overall diabetes management; MNT focuses specifically on nutrition.

2. Forgetting the Physician Order Requirement

DSMT requires a physician (or qualified non-physician practitioner) order. MNT requires a physician referral. Without the appropriate order or referral, Medicare will deny the claim.

3. Missing the 10-Hour DSMT Initial Limit

The 10 hours of initial DSMT must be completed within 12 months of the first session. Hours remaining after 12 months expire. Plan the schedule accordingly.

4. Using a Non-Accredited DSMT Program

Only ADA Education Recognition Program or ADCES accredited programs are CMS-approved for DSMT. Services from non-accredited programs are not covered.

5. Missing the Registered Dietitian Requirement for MNT

MNT must be furnished by a Registered Dietitian or qualified nutrition professional meeting 42 CFR 410.134. Services from non-RDs (health coaches, certified diabetes educators who are not RDs) are not covered as MNT.

6. Confusing MNT for Diabetes with MNT for CKD

MNT covers diabetes and CKD non-dialysis under separate indications. The hour limits (3 initial, 2 subsequent) apply to the patient, not to each indication separately. CMS does not double-count hours when a beneficiary qualifies under multiple indications.

7. Believing MDPP Has Cost-Sharing

MDPP has NO beneficiary cost-sharing. The MDPP is unique among Part B services in this regard. The supplier receives performance-based payment from Medicare, but the beneficiary pays nothing.

8. Assuming All Prediabetes Patients Qualify for MDPP

MDPP coverage requires specific HbA1c (5.7 to 6.4), fasting plasma glucose (110 to 125 mg/dL), or OGTT (140 to 199 mg/dL) values within the 12 months preceding the first session, plus BMI ≥ 25 (or ≥ 23 for Asian beneficiaries), plus no previous diabetes diagnosis (other than gestational), plus no ESRD on dialysis.

9. Missing MDPP Attendance Requirements

MDPP payment is performance-based, tied to attendance milestones (1, 4, 9 sessions) and weight-loss milestones (5 percent loss, sustained maintenance). Failing to attend the required sessions reduces both the supplier payment and the beneficiary's clinical benefit.

10. Overlooking Telehealth Options for Rural Patients

DSMT and MNT may be furnished via telehealth under extended COVID telehealth flexibilities. Rural beneficiaries should ask their PCP or DSMT/MNT provider about telehealth delivery to avoid travel burden.

11. Confusing CKD MNT with ESRD-PPS Coverage

MNT covers CKD non-dialysis (stages 3 through 5). ESRD on dialysis is covered under the ESRD Prospective Payment System (Section 1881), which includes nutrition counseling as part of the bundled payment. MNT does NOT apply to ESRD-PPS patients separately.

12. Failing to Renew DSMT Annually

After the initial 10-hour DSMT, beneficiaries are entitled to 2 hours of follow-up DSMT each subsequent 12-month period. The 12-month clock resets after the initial DSMT, and a new physician order is required for the annual follow-up.

13. Missing the DSMT Group Session Preference

Medicare prefers group DSMT over individual DSMT. Beyond the initial 1 hour of individual training, additional individual training is covered only when group classes are unavailable within 2 months, when the physician documents specific medical conditions warranting individual training, or when the beneficiary needs further training after group sessions.

14. Not Asking About MDPP Virtual Options

Even when in-person MDPP suppliers (YMCAs, hospital programs) are not local, CMS-recognized virtual MDPP suppliers (Lark Health, Omada Health, Health Catalyst, others) serve Georgia beneficiaries statewide. Rural beneficiaries should explore virtual options.

Brevy and How We Can Help

Brevy (brevy.com) is an eldercare advocacy organization that helps Georgia Medicare beneficiaries and their families understand Medicare coverage rules, including DSMT, MNT, and MDPP. We can help you understand whether your DSMT or MNT services are covered, verify that your DSMT program is ADA or ADCES accredited, confirm that your MNT provider meets Registered Dietitian requirements, determine whether you qualify for MDPP, locate CMS-recognized MDPP suppliers in Georgia, and decide whether to appeal a denied claim. We do not provide medical care; we provide information and advocacy.

::: accordion Q1: What is Diabetes Self-Management Training (DSMT)?

DSMT is an outpatient educational program for Medicare beneficiaries with diabetes that teaches self-care behaviors and skills. The benefit is established by Section 1861(qq) of the Social Security Act, added by BBA 1997 Section 4105. Implementing regulation is at 42 CFR 410.140 through 410.146.

Q2: What is Medical Nutrition Therapy (MNT)?

MNT is nutritional diagnostic, therapeutic, and counseling services for disease management. The benefit is established by Section 1861(vv) of the Social Security Act, added by BIPA 2000 Section 105. Implementing regulation is at 42 CFR 410.130 through 410.134. MNT covers diabetes, chronic kidney disease (non-dialysis), and post-kidney-transplant patients.

Q3: How many hours of DSMT does Medicare cover?

Medicare covers up to 10 hours of initial DSMT in the first 12 months after a physician order (1 hour individual + 9 hours group), plus 2 hours of follow-up training each subsequent 12-month period.

Q4: How many hours of MNT does Medicare cover?

Medicare covers 3 hours of MNT in the first calendar year and 2 hours in each subsequent calendar year. Additional hours may be covered when the treating physician documents a change in the beneficiary's condition.

Q5: Who can provide DSMT?

DSMT must be furnished by a certified provider that has been accredited by the ADA Education Recognition Program or the ADCES (formerly AADE). The provider may be a hospital, physician office, FQHC, RHC, or other entity meeting accreditation standards.

Q6: Who can provide MNT?

MNT must be furnished by a Registered Dietitian or qualified nutrition professional meeting 42 CFR 410.134: bachelor's or higher degree in nutrition or dietetics, at least 900 hours of supervised practice or accredited internship, and state licensure or certification.

Q7: Does Medicare cover diabetes prevention?

Yes. The Medicare Diabetes Prevention Program (MDPP), authorized by ACA Section 4108 and expanded by the CMS Innovation Center effective April 1, 2018, provides a 12-month structured lifestyle change program for beneficiaries with prediabetes. The MDPP is modeled on the CDC's National Diabetes Prevention Program.

Q8: Who qualifies for MDPP?

MDPP coverage requires HbA1c 5.7 to 6.4 percent, fasting plasma glucose 110 to 125 mg/dL, or 2-hour OGTT 140 to 199 mg/dL within the 12 months preceding the first session; BMI ≥ 25 (or ≥ 23 for Asian beneficiaries); no previous diabetes diagnosis (other than gestational); and no ESRD on dialysis.

Q9: How much does DSMT cost the beneficiary?

DSMT has 20 percent Part B coinsurance after the annual Part B deductible. Medicare Supplement Plans G and N typically cover the coinsurance.

Q10: How much does MNT cost the beneficiary?

MNT has 20 percent Part B coinsurance after the annual deductible. In rare preventive contexts, MNT may be cost-shared at 0 percent under the ACA preventive services framework.

Q11: How much does MDPP cost the beneficiary?

NOTHING. MDPP has NO beneficiary cost-sharing. The MDPP is unique among Part B services in this regard. The supplier receives performance-based payment from Medicare; the beneficiary pays nothing.

Q12: Can DSMT be furnished via telehealth?

Yes, under the extended COVID telehealth flexibilities (CAA 2022, CAA 2023, and subsequent legislative extensions). DSMT may be furnished via telehealth in approved circumstances as of 2026.

Q13: Can MNT be furnished via telehealth?

Yes, under the same extended telehealth framework. MNT may be furnished via telehealth in approved circumstances as of 2026.

Q14: What are the MDPP structure and milestones?

MDPP includes 16 weekly core sessions in the first 6 months, 6 monthly core sessions in months 7 through 12, and optional ongoing maintenance (12 monthly sessions in year 2) for beneficiaries who achieve and maintain 5 percent weight loss. Payment to the supplier is performance-based, tied to attendance and weight-loss milestones.

Q15: How do I find an accredited DSMT program in Georgia?

ADA and ADCES maintain online directories of accredited programs. Major Georgia hospital systems (Emory, Piedmont, Wellstar, NGHS, Memorial Health, AU/Wellstar MCG, Phoebe, Grady, Atrium Navicent, Tanner) operate accredited DSMT programs. Independent endocrinology practices and FQHCs/RHCs may also operate accredited programs.

Q16: How do I find an MNT-eligible Registered Dietitian in Georgia?

The Georgia Board of Examiners of Licensed Dietitians maintains a directory of licensed RDs. The Academy of Nutrition and Dietetics directory also lists Georgia RDs. Major hospital diabetes education centers employ RDs who provide MNT. Independent RD practices accept Medicare for MNT services.

Q17: How do I find an MDPP supplier in Georgia?

CMS maintains a directory of CMS-recognized MDPP suppliers. In-person Georgia suppliers include YMCA of Metro Atlanta, YMCA of Coastal Georgia, and selected hospital programs. Virtual MDPP suppliers (Lark Health, Omada Health, Health Catalyst, others) serve Georgia beneficiaries statewide.

Q18: Does MNT cover renal nutrition for CKD?

Yes. MNT covers chronic kidney disease not on dialysis (typically CKD stages 3 through 5). The hour limits (3 initial, 2 subsequent) apply to the beneficiary, not separately for each qualifying condition.

Q19: Does MNT cover obesity counseling?

No. MNT specifically covers diabetes, CKD non-dialysis, and post-kidney-transplant patients. Obesity counseling for non-diabetes indications is covered under the Intensive Behavioral Therapy for Obesity benefit (HCPCS G0447), a separate Part B service.

Q20: Can I receive DSMT and MNT in the same year?

Yes. DSMT and MNT are separate benefits and can be received concurrently. DSMT focuses on overall diabetes management; MNT focuses specifically on nutrition. Both can be valuable for newly diagnosed diabetes patients.

Q21: What is the CDC National Diabetes Prevention Program?

The CDC National Diabetes Prevention Program is the public health framework on which MDPP is modeled. The CDC certifies organizations to deliver the National DPP curriculum, and CMS in turn recognizes CDC-certified organizations as MDPP suppliers when they meet additional Medicare-specific requirements.

Q22: Can I appeal a denied DSMT, MNT, or MDPP claim?

Yes. Under Original Medicare, you have five levels of appeal: redetermination by Palmetto GBA Jurisdiction J, reconsideration by a Qualified Independent Contractor, ALJ hearing, Medicare Appeals Council, and federal district court. Medicare Advantage and Part D have similar five-level appeals frameworks. GeorgiaCares SHIP, the Medicare Rights Center, and other free resources can assist.

Q23: Does Medicare Advantage cover DSMT and MNT?

Yes. Medicare Advantage plans must cover DSMT and MNT under the Medicare Advantage parity rule. Cost-sharing may differ from Original Medicare. Some MA plans offer expanded DSMT or MNT as supplemental benefits.

Q24: Are DSMT and MNT counted toward the Part B deductible?

Yes. DSMT and MNT services apply toward the annual Part B deductible ($278 in 2026), just like other Part B services.

Q25: How can Brevy help me with DSMT, MNT, or MDPP questions?

Brevy (brevy.com) helps Georgia Medicare beneficiaries understand DSMT, MNT, and MDPP coverage rules. We can verify whether your DSMT program is ADA or ADCES accredited, confirm your MNT provider's Registered Dietitian credentials, determine your MDPP eligibility, locate CMS-recognized MDPP suppliers, read your explanation of benefits, and connect you with GeorgiaCares SHIP and other free counseling resources. :::

Standard Disclaimers

This article is for general informational purposes only and does not constitute legal, medical, financial, or insurance advice. Medicare rules, payment rates, coverage policies, and provider directories change periodically. Verify all information with the relevant Medicare Administrative Contractor, the Centers for Medicare and Medicaid Services, your provider, your DSMT/MNT/MDPP supplier, and your Medicare Supplement or Medicare Advantage plan before making decisions. Brevy (brevy.com) provides advocacy and information services; we do not provide medical care or legal representation, and the content of this article does not establish any provider-patient or attorney-client relationship.

::: cta Contact Resources for Georgia Medicare DSMT, MNT, and MDPP

1. Medicare : 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, medicare.gov
2. Palmetto GBA Jurisdiction J (Georgia Medicare Administrative Contractor) : 1-877-567-9230
3. Kepro QIO (Beneficiary and Family-Centered Care Quality Improvement Organization) : 1-844-455-8708
4. GeorgiaCares SHIP (Georgia's State Health Insurance Assistance Program) : 1-866-552-4464
5. Georgia DCH Medicaid Member Services : 1-866-211-0950
6. American Diabetes Association : 1-800-342-2383, diabetes.org
7. Association of Diabetes Care and Education Specialists (ADCES) : 1-800-338-3633, diabeteseducator.org
8. Academy of Nutrition and Dietetics : 1-800-877-1600, eatright.org
9. CDC National Diabetes Prevention Program : cdc.gov/diabetes/prevention
10. Georgia Department of Public Health Diabetes Prevention and Control Program : 404-657-2700
11. Georgia Board of Examiners of Licensed Dietitians : sos.ga.gov
12. Social Security Administration : 1-800-772-1213, TTY 1-800-325-0778, ssa.gov
13. HHS Office for Civil Rights : 1-800-368-1019, TTY 1-800-537-7697
14. HHS Office of Inspector General Hotline : 1-800-447-8477 (1-800-HHS-TIPS)
15. Medicare Rights Center : 1-800-333-4114, medicarerights.org
16. Center for Medicare Advocacy : 1-860-456-7790, medicareadvocacy.org
17. Atlanta Legal Aid Society : 404-377-0701, atlantalegalaid.org
18. Georgia Legal Services Program : 1-800-498-9469, glsp.org
19. Eldercare Locator : 1-800-677-1116
20. 211 Georgia (United Way of Greater Atlanta) : dial 2-1-1 :::