405 IAC 5-36-3 - Limitations on coverage of DSMT
Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-15; IC 27-8-14.5
Sec. 3.
(a) Coverage
of DSMT is limited to sixteen (16) units of DSMT per member, per rolling
calendar year without prior authorization. Additional units of DSMT may be
authorized via the prior authorization process as set forth in
405 IAC 5-3.
(b) Coverage of DSMT is limited to the
following clinical circumstances:
(1) Receipt
of a diagnosis of diabetes.
(2)
Receipt of a diagnosis that represents a significant change in the patient's
symptoms or condition.
(3)
Re-education or refresher training.
Notes
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