Medical Policy: 09.01.01 
Original Effective Date: February 1989 
Reviewed: May 2016 
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 education and self-management training is a formalized, comprehensive outpatient program that teaches individuals who have been diagnosed with diabetes about their diagnosis and its treatment. Components of such programs typically include, but are not limited to the following: blood glucose self-monitoring; dietary requirements; exercise and its role in the management of diabetes; if necessary, instruction on the self-administration of pharmaceutical agents for the treatment of diabetes, as well as an insulin treatment plan.


Diabetes education programs provided in Iowa, according to State law, must 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 supplies 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 ProgramExternal Site 
  • Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management educationExternal Site Diabetes Care(serial online). 2009;32:S87-S94. [Diabetes Care Web site].

Policy History:

  • May 2016 - Annual Review, Policy Renewed
  • June 2015 - Annual Review, Policy Revised
  • July 2014 - Annual Review, Policy Renewed
  • September 2013 - Annual Review, Policy Renewed
  • October 2012 - Annual Review, Policy Renewed
  • November 2011 - Annual Review, Policy Renewed
  • October 2010 - Annual Review, Policy Renewed

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.