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Diabetes Outpatient Self-Management Training and Education (Iowa Only)

» Summary» Procedure Codes
» Description» Selected References
» Prior Approval» Policy History
» Policy

Medical Policy: 09.01.01 
Original Effective Date: February 1989 
Reviewed: June 2015 
Revised: June 2015 

Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.


Diabetes is a chronic illness that requires continuing medical care and education in order to prevent acute complications and reduce the risks of developing other conditions related to uncontrolled blood glucose. These other conditions may include retinopathy, nephropathy, neuropathy, and cardiovascular disease.


Outpatient diabetes training is a program that educates patients in the successful self-management of diabetes. The program includes education about self-monitoring of blood glucose and diet and exercise, as well as an insulin treatment plan for those who are insulin dependent. Diabetes education programs provided in Iowa must, according to State law, be certified by the Iowa Department of Public Health.


Prior Approval: 


Not applicable



When diagnosed with any type of diabetes and prescribed by a physician, the following services are considered medically necessary

  • Blood glucose meter and glucose strips for self-monitoring at home.
  • Outpatient diabetes self-management training or education program certified by the Iowa Department of Health:
    • At least 10 hours of initial training provided within a continuous 12 month period; and 
    • Up to 2 hours of follow up diabetes self-management training or education annually each subsequent year for those who have completed the initial training.

Diabetes outpatient self-management training is considered not medically necessary if the above criteria are not met.


Procedure Codes and Billing Guidelines: 

  • To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.
  • Providers may use the following HCPCS codes to report diabetes outpatient education and training:
    • G0108  Diabetes outpatient self management training services, individual session/30 minutes 
    • G0109  Diabetes outpatient self management training services, group sessions/30 minutes
    • S9140  Diabetic management program, follow up visit to non-MD provider

    • S9141  Diabetic management program, follow up visit to MD provider

    • S9455  Diabetic management program, group session

    • S9460  Diabetic management program, nurse visit

    • S9465  Diabetic management program, dietician visit


Selected References: 

  • Iowa Code 2003: Section 514C.18 Diabetes Coverage.
  • American Diabetes Association (2003) Third party reimbursement for diabetes care, self-management education, and supplies. Diabetes Care, 26(1),S143-S144.
  • American Diabetes Association. Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies. Diabetes Care January 2009 32:S85-S86.
  • Iowa Code 2009: Section 514C.18 Diabetes Coverage
  • Iowa Department of Public Health: Iowa Diabetes Prevention & Control Program
  • Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education. Diabetes Care(serial online). 2009;32:S87-S94. [Diabetes Care Web site]. Available at:


Policy History: 


Date                                        Reason                              Action

October 2010                         Annual review                    Policy renewed

November 2011                     Annual review                     Policy renewed

October 2012                        Annual review                     Policy renewed

September 2013                   Annual review                      Policy renewed

July 2014                             Annual review                      Policy renewed 

June 2015                            Annuarl review                     Policy revised



Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

*Current Procedural Terminology © 2012 American Medical Association. All Rights Reserved.

Contact Information
New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
  Wellmark Blue Cross and Blue Shield
  Medical Policy Analyst
  P.O. Box 9232
  Des Moines, IA 50306-9232
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