405 IAC 5-36-3 Limitations on coverage of DSMT

Sec. 3. (a) Coverage of DSMT is limited to sixteen (16) units of DSMT for each member each calendar year without prior authorization. Additional units of DSMT may be authorized in accordance with the prior authorization process as set forth in 405 IAC 5-3. (b) Coverage of DSMT is limited to the following clinical circumstances: (1) Receiving a diagnosis of diabetes. (2) Receiving a diagnosis that represents a significant change in the patient's symptoms or condition. (3) Reeducation or refresher training.