Billing codes · HCPCS code

G0108 and G0109: diabetes self-management training codes

By Javier Alvarez · Updated September 28, 2026 · 4 min read

Diabetes self-management training (DSMT) and medical nutrition therapy (MNT) are separate Medicare benefits. They often reach the same patients, and dietitians often teach in both. The codes, the rules, and above all who can bill are different, and mixing them up is how DSMT claims from unaccredited practices get denied.

DSMT vs MNT at a glance

Sources: 42 CFR 410.141, 42 CFR 410.132, Medicare.gov, Noridian.

The accreditation requirement

This is the rule that matters most for a private-practice dietitian. Under 42 CFR 410.141(e), DSMT may be furnished by a physician, individual or entity that:

1. Furnishes other services Medicare pays for directly
2. Can properly receive Medicare payment
3. Is accredited by a CMS-approved accreditation organization to one of the recognized quality standards
4. Provides outcome documentation to CMS on request

Noridian's DSMT page names the American Diabetes Association and the Association of Diabetes Care & Education Specialists (ADCES) as CMS-approved national accrediting organizations. In Noridian's words, "DSMT programs are credentialed, not individual providers."

In practice:

• An RD with an accredited program (their own or one they're part of) can bill G0108/G0109 as the program's billing provider.
• An RD without accreditation can't bill DSMT, however much diabetes education a visit includes. Bill the visit as MNT (97802/97803) if the patient qualifies.
• A CDCES credential isn't program accreditation. The credential is personal; accreditation belongs to the program.

Hours and units

Initial training (42 CFR 410.141(c)):

• Up to 10 hours within a continuous 12-month period, for a beneficiary who hasn't had initial training before
• 9 hours in a group of 2 to 20 people (not all need to be Medicare beneficiaries)
• Up to 1 hour individual for assessing training needs
• Individual training beyond that only if no group session is available within 2 months, or the ordering practitioner documents special needs (for example severe vision, hearing or language limitations) that would hinder group participation. Noridian also lists additional insulin training ordered by the practitioner.

Follow-up training: up to 2 hours per calendar year, individual or group, starting the calendar year after initial training is completed. The ordering practitioner documents the condition the follow-up addresses.

Units: both codes are per 30 minutes, and training must be furnished in increments of no less than half an hour. A 60-minute group class is G0109 × 2 for each participant. A 30-minute individual assessment is G0108 × 1. Medicare's practitioner MUEs (effective October 1, 2026) are 6 units per day for G0108 and 12 units per day for G0109.

Billing DSMT and MNT in the same year

CMS's claims manual settles the overlap question: the NCD "allows a beneficiary to receive the full amount of both benefits in the same period," so a patient can get the full 10 hours of initial DSMT and the full 3 hours of MNT. The limits:

• Not on the same date of service for the same beneficiary. CMS runs a duplicate edit to catch DSMT and MNT billed for the same date, even when one comes from a hospital and the other from a professional claim (ch. 4, §300.1 and §300.6).
• A change in condition. If a patient who had DSMT is also diagnosed with kidney disease in the same episode of care, MNT can continue based on that change, which is where G0270 comes in.

A workable pattern for a dietitian inside an accredited program: DSMT classes on one day, individual MNT on another, each with its own order or referral, codes and notes.

Orders, telehealth and diagnosis

• Order and plan of care. DSMT needs an order from the physician or qualified non-physician practitioner treating the patient's diabetes, and a plan of care that practitioner signs. MNT needs a physician referral. They're different documents.
• Telehealth. G0108 and G0109 are both on the CY 2026 Medicare telehealth list.
• Diagnosis. DSMT is for beneficiaries diagnosed with diabetes; code the type and complications the practitioner documented. See E11 type 2 diabetes codes.

Common DSMT billing mistakes

For how MNT fits around DSMT across a patient's year, see the Medicare MNT billing guide.