Download:
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pdfOMB control number: 0938-1146
Expiration date: XX/XX/20XX
Managing Type 2 Diabetes Guide
Label and Assumptions
Instructions to Plans and Issuers: Do not modify this table. The numbers shown here come from the
Scenario table.
Table 1. Managing Type 2 Diabetes Sample Care Costs
Managing Type 2 Diabetes
Professional Services: Primary Care
Professional Services: Specialist
Diagnostic Services: Laboratory
Prescription Drugs: Generic
Prescription Drugs: Insulin
Over-the-counter Drugs
Preventative Services & Vaccines
Medical Supplies
Total
Sample Care Costs
$716
$301
$122
$365
$3,125
$22
$159
$790
$5,601
Assumptions
The following are assumptions that all group health plans and insurance issuers must use for this
scenario. These assumptions are standard across all scenarios.
•
•
•
•
•
•
•
•
•
•
•
•
Costs do not include premiums.
Condition was not excluded as a pre-existing condition.
There are no other medical expenses for any member covered under the plan or policy.
All care is in-network and considered first tier (or the tier associated with the lowest level of cost
sharing), for those products that incorporate tiered provider networks.
No out-of-network charges or any other variation in sample care costs.
All services occur in same policy period.
All prior authorizations were obtained.
All services were deemed medically necessary.
All costs (allowed amount, sample care costs, member costs) greater than $100 are rounded to
the nearest hundred.
All costs (allowed amount, sample care costs, member costs) less than $100 are rounded to the
nearest ten.
If applying the rounding rules causes the cost sharing amount displayed to exceed the actual
out-of-pocket limit (for self-only coverage), then the cost sharing amount must be capped and
the amount of the actual out-of-pocket limit must be used. For example, if the out-of-pocket
limit is $5,000 but applying the rounding rules makes the sum of the deductible, copayment and
coinsurance equal to $5,100, the plan or issuer must use the out-of-pocket limit of “$5,000” and
not “$5,100.” This amount (the $5,000 out-of-pocket limit) must then be added to the monetary
amount in the exclusions and limits to determine the total Patient pays amount.
All medications are covered as generic equivalents if available.
•
If the plan has a wellness program that varies the deductibles, copayments, coinsurance, or
coverage for any of the services listed in a treatment scenario, the plan or issuer must complete
the calculations for that treatment scenario assuming that the patient is NOT participating in the
wellness program.
Scenario
Medical Condition: Managing Type 2 Diabetes
Note: Services are listed individually for classification and pricing purposes to facilitate the population of
the “Sample care costs” section. HHS specifies the Category in order to roll up costs into that category in
the "Sample care costs" section so that those costs are uniform across all group health plans and health
insurance issuers. However, some plans or issuers may classify an item or service under another
category. The plan or issuer should apply its cost sharing and benefit features for each plan or policy in
order to complete the “You pay” section, but must leave as is the "Sample care costs" section. Examples
of cost sharing and benefit features include, but are not limited to:
•
•
Payment of services based on the location such as inpatient, outpatient, or office; and
Payment of items as prescription drugs vs. medical equipment.
Explanation of Scenario
• Total – the sum of allowed amounts for the listed items and services, which is cross-referenced
in the "Label and Assumptions" tab, where it is rounded.
• Date of Service – includes the day and month of service so plans and issuers understand the
order in which items or services are rendered.
• ICD-10 Diagnosis Code – includes the ICD-10 code for each item or service.
• CPT, HCPCS or Other Billing Code – includes medical codes for each item or service. Over-thecounter medications are listed as OTC.
• Provider Type – includes one of the types listed on the "Provider Types" tab to classify each item
or service by provider.
• Category – includes one of the categories listed on the "Categories" tab to classify each item or
service so it rolls up into the same category in the "Label and Assumptions" tab.
• Description – includes the short form descriptor for a CPT code, or an appropriate descriptor for
a non-CPT billing code.
• Allowed Amount – includes an estimated national average allowed amount for each item or
service, which plans or issuers must use to calculate cost sharing.
CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of
the American Medical Association.
OMB Control Numbers 1545-0047, 1210-0147, and 0938-1146
Table 2. Managing Type 2 Diabetes Scenario Timeline
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
Category
Description
Totals:
Allowed
Amount
$5,601.10
3-Jan
No data
8290328279
Pharmacy
Retail
Medical
Supplies
3-Jan
No data
53885039310
Pharmacy
Retail
Medical
Supplies
3-Jan
No data
53885014201
3-Jan
No data
53885044801
3-Jan
No data
53885024510
Pharmacy
Retail
Pharmacy
Retail
Pharmacy
Retail
Medical
Supplies
Medical
Supplies
Medical
Supplies
3-Jan
No data
53885045802
3-Jan
No data
OTC
Pharmacy
Retail
Pharmacy
Retail
3-Jan
No data
2803101
Pharmacy
Retail
3-Jan
No data
88222033
Pharmacy
Retail
Medical
Supplies
Over-thecounter
Drugs
Prescription
Drugs:
Generic
Prescription
Drugs:
Insulin
3-Jan
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
3-Jan
No data
68180051503
Pharmacy
Retail
3-Jan
No data
378395277
Pharmacy
Retail
3-Jan
E119.00,
Z7982,
Z794
82570
Primary
Prescription
Drugs:
Generic
Prescription
Drugs:
Generic
Diagnostic
Services:
Laboratory
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
OneTouch Delica
Lancets (100 per box)
[usage = 60 lancets per
month]
OneTouch Delica
Lancing Device
OneTouch Ultra 2 Blood
Glucose Meter Kit
OneTouch Ultra Blue
Test Strips (Rx - box of
100) [usage = 2
strips/day; 60 per
month]
OneTouch Ultra Control
Solution (2 vials/box)
Aspirin 81mg (OTC bottle 100) [usage = 1
QD; #30 pills per month]
Glucagon Emergency Kit
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
Metformin
Hydrochloride 500 MG
TABLET [#60
pilles/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
Atorvastatin 40 MG
tablet 90 CT [ #30
pills/month]
Assay of Urine
Creatinine
$20.62
$8.73
$14.33
$14.70
$109.61
$6.63
$4.47
$241.05
$240.37
$3.21
$3.38
$9.66
$9.53
Date
ICD-10
of
Diagnosis
Service
Code
3-Jan
3-Jan
3-Jan
3-Jan
3-Jan
3-Jan
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
CPT©, HCPCS, or
Other Billing Code
Provider
Type
80053
Primary
83036
Primary
80061
Primary
82043
Primary
36415
Primary
99214
Primary
4-Jan
E119.00,
Z7982,
Z794
G0108
Diabetes
Educator
4-Jan
E119.00,
Z7982,
Z794
97803
Dietician
6-Jan
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
99204
Podiatry
92014
Ophthalmology
88222033
Pharmacy
Retail
7-Jan
31-Jan
No data
Category
Diagnostic
Services:
Laboratory
Diagnostic
Services:
Laboratory
Diagnostic
Services:
Laboratory
Diagnostic
Services:
Laboratory
Diagnostic
Services:
Laboratory
Professional
Services:
Primary
Care
Professional
Services:
Primary
Care
Professional
Services:
Primary
Care
Professional
Services:
Specialist
Professional
Services:
Specialist
Prescription
Drugs:
Insulin
Description
Allowed
Amount
Comprehen Metabolic
Panel
$29.63
Glycosylated
Hemoglobin Test
$16.98
Lipid panel
$23.40
Microalbumin
Quantitative
$13.10
Routine Venipuncture
$6.43
Office/Outpatient Visit
Est
$121.70
Diabetes outpatient
self-management
training services,
individual, per 30
minutes
Med Nutrition Indiv
Subseq
$77.82
$36.83
Office/Outpatient Visit
New
$182.19
Ophthalmological
services: medical
examination &
evaluation, with
initiation or
continuation of
diagnostic and
treatment program,
comprehensive,
established patient, 1 or
more visits
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
$118.55
$240.37
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
Category
2-Feb
No data
8290328279
Pharmacy
Retail
Medical
Supplies
2-Feb
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
2-Feb
No data
68180051503
Pharmacy
Retail
28-Feb
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Generic
Prescription
Drugs:
Insulin
4-Mar
No data
8290328279
Pharmacy
Retail
Medical
Supplies
4-Mar
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
4-Mar
No data
68180051503
Pharmacy
Retail
28-Mar
No data
OTC
Pharmacy
Retail
28-Mar
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Generic
Over-thecounter
Drugs
Prescription
Drugs:
Insulin
28-Mar
E119.00,
Z7982,
Z794
99214
Primary
3-Apr
No data
8290328279
Pharmacy
Retail
3-Apr
No data
68382075810
Pharmacy
Retail
Professional
Services:
Primary
Care
Medical
Supplies
Prescription
Drugs:
Generic
Description
Allowed
Amount
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$20.62
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$240.37
Aspirin 81mg (OTC bottle 100) [usage = 1
QD; #30 pills per month]
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
Office/Outpatient Visit
Est
$4.47
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
$3.21
$3.38
$20.62
$3.21
$3.38
$240.37
$121.70
$20.62
$3.21
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
Category
3-Apr
No data
68180051503
Pharmacy
Retail
3-Apr
No data
378395277
Pharmacy
Retail
12-Apr
No data
53885039310
Pharmacy
Retail
Prescription
Drugs:
Generic
Prescription
Drugs:
Generic
Medical
Supplies
12-Apr
No data
53885024510
Pharmacy
Retail
Medical
Supplies
25-Apr
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Insulin
3-May
No data
8290328279
Pharmacy
Retail
Medical
Supplies
3-May
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
3-May
No data
68180051503
Pharmacy
Retail
23-May
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Generic
Prescription
Drugs:
Insulin
2-Jun
No data
8290328279
Pharmacy
Retail
Medical
Supplies
2-Jun
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
2-Jun
No data
68180051503
Pharmacy
Retail
Prescription
Drugs:
Generic
Description
Allowed
Amount
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$3.38
Atorvastatin 40 MG
tablet 90 CT [ #30
pills/month]
OneTouch Delica
Lancets (100 per box)
[usage = 60 lancets per
month]
OneTouch Ultra Blue
Test Strips (Rx - box of
100) [usage = 2
strips/day; 60 per
month]
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$9.66
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$8.73
$109.61
$240.37
$20.62
$3.21
$3.38
$240.37
$20.62
$3.21
$3.38
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
20-Jun
No data
603002632
Pharmacy
Retail
20-Jun
No data
88222033
Pharmacy
Retail
27-Jun
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
E119.00,
Z7982,
Z794
83036
Primary
36415
Primary
99214
Primary
27-Jun
27-Jun
Category
Description
Over-thecounter
Drugs
Prescription
Drugs:
Insulin
Aspirin 81mg (OTC bottle 100) [usage = 1
QD; #30 pills per month]
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
Glycosylated
Hemoglobin Test
Diagnostic
Services:
Laboratory
Diagnostic
Services:
Laboratory
Professional
Services:
Primary
Care
Professional
Services:
Primary
Care
28-Jun
E119.00,
Z7982,
Z794
G0108
Diabetes
Educator
28-Jun
E119.00,
Z7982,
Z794
97803
Dietician
2-Jul
No data
8290328279
Pharmacy
Retail
2-Jul
No data
53885045802
2-Jul
No data
68382075810
Pharmacy
Retail
Pharmacy
Retail
Medical
Supplies
Prescription
Drugs:
Generic
2-Jul
No data
68180051503
Pharmacy
Retail
2-Jul
No data
378395277
Pharmacy
Retail
Prescription
Drugs:
Generic
Prescription
Drugs:
Generic
Professional
Services:
Primary
Care
Medical
Supplies
Allowed
Amount
$4.47
$240.37
$16.98
Routine Venipuncture
$6.43
Office/Outpatient Visit
Est
$121.70
Diabetes outpatient
self-management
training services,
individual, per 30
minutes
Med Nutrition Indiv
Subseq
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
OneTouch Ultra Control
Solution (2 vials/box)
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
Atorvastatin 40 MG
tablet 90 CT [ #30
pills/month]
$77.82
$36.83
$20.62
$6.63
$3.21
$3.38
$9.66
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
Category
Description
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
OneTouch Ultra Blue
Test Strips (Rx - box of
100) [usage = 2
strips/day; 60 per
month]
OneTouch Delica
Lancets (100 per box)
[usage = 60 lancets per
month]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
18-Jul
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Insulin
21-Jul
No data
53885024510
Pharmacy
Retail
Medical
Supplies
21-Jul
No data
53885039310
Pharmacy
Retail
Medical
Supplies
1-Aug
No data
8290328279
Pharmacy
Retail
Medical
Supplies
1-Aug
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
1-Aug
No data
68180051503
Pharmacy
Retail
15-Aug
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Generic
Prescription
Drugs:
Insulin
31-Aug
No data
8290328279
Pharmacy
Retail
Medical
Supplies
31-Aug
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
31-Aug
No data
68180051503
Pharmacy
Retail
12-Sep
No data
OTC
Pharmacy
Retail
Prescription
Drugs:
Generic
Over-thecounter
Drugs
Allowed
Amount
$240.37
$109.61
$8.73
$20.62
$3.21
$3.38
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$240.37
Aspirin 81mg (OTC bottle 100) [usage = 1
QD; #30 pills per month]
$4.47
$20.62
$3.21
$3.38
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
Category
Description
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
Office/Outpatient Visit
Est
12-Sep
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Insulin
26-Sep
E119.00,
Z7982,
Z794
99214
Primary
30-Sep
No data
8290328279
Pharmacy
Retail
Professional
Services:
Primary
Care
Medical
Supplies
30-Sep
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
30-Sep
No data
68180051503
Pharmacy
Retail
3-Oct
Z23
90472
Primary
3-Oct
Z23
90471
Primary
3-Oct
Z23
90732
Primary
Prescription
Drugs:
Generic
Preventive
Services &
Vaccines
Preventive
Services &
Vaccines
Preventive
Services &
Vaccines
3-Oct
Z23
90656
Primary
3-Oct
No data
378395277
Pharmacy
Retail
10-Oct
No data
88222033
Pharmacy
Retail
29-Oct
No data
53885039310
Pharmacy
Retail
Preventive
Services &
Vaccines
Prescription
Drugs:
Generic
Prescription
Drugs:
Insulin
Medical
Supplies
Allowed
Amount
$240.37
$121.70
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$20.62
Immunization admin
each add
$15.88
Immunization Admin
$28.31
Vaccine for
pneumococcal
polysaccharide for
injection beneath the
skin or into muscle,
patient 2 years or older
Flu Vaccine No Preserv 3
&>
$93.74
Atorvastatin 40 MG
tablet 90 CT [ #30
pills/month]
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
OneTouch Delica
Lancets (100 per box)
[usage = 60 lancets per
month]
$9.66
$3.21
$3.38
$21.02
$240.37
$8.73
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
Category
29-Oct
No data
53885024510
Pharmacy
Retail
Medical
Supplies
30-Oct
No data
8290328279
Pharmacy
Retail
Medical
Supplies
30-Oct
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
30-Oct
No data
68180051503
Pharmacy
Retail
7-Nov
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Generic
Prescription
Drugs:
Insulin
29-Nov
No data
8290328279
Pharmacy
Retail
Medical
Supplies
29-Nov
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
29-Nov
No data
68180051503
Pharmacy
Retail
5-Dec
No data
OTC
Pharmacy
Retail
5-Dec
No data
88222033
Pharmacy
Retail
Prescription
Drugs:
Generic
Over-thecounter
Drugs
Prescription
Drugs:
Insulin
29-Dec
No data
8290328279
Pharmacy
Retail
Medical
Supplies
29-Dec
No data
53885045802
Pharmacy
Retail
Medical
Supplies
Description
Allowed
Amount
OneTouch Ultra Blue
Test Strips (Rx - box of
100) [usage = 2
strips/day; 60 per
month]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$109.61
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
$240.37
Aspirin 81mg (OTC bottle 100) [usage = 1
QD; #30 pills per month]
Insulin glargine 100
unit/ml injectable
solution (Rx - 10ml vial)
[20 units QD; expires 28
days after first use]
BD Ultrafine Insulin
Syringes / 30G/ 0.5cc
[usage = 30 syringes per
month]
OneTouch Ultra Control
Solution (2 vials/box)
$4.47
$20.62
$3.21
$3.38
$20.62
$3.21
$3.38
$240.37
$20.62
$6.63
Date
ICD-10
of
Diagnosis
Service
Code
CPT©, HCPCS, or
Other Billing Code
Provider
Type
Category
29-Dec
No data
68382075810
Pharmacy
Retail
Prescription
Drugs:
Generic
29-Dec
No data
68180051503
Pharmacy
Retail
Prescription
Drugs:
Generic
Description
Allowed
Amount
Metformin
Hydrochloride 500 MG
TABLET [ #60
pills/month]
Lisinopril 20mg (Rx) [1
QD; #30 pills/month]
** Inpatient costs were calculated based on national averages using the indicated DRG codes. Additional
variances may occur based on how health plan hospital contracts are structured (e.g., case rate, per
diems, percentage of billed charges, etc.)
Provider Types
The following are the provider types to use in the “Scenario” table ~ "Provider Type" column to classify
each service by provider type. This aids group health plans and health insurance issuers in applying
benefits to each item and service.
Table 3. Managing Type 2 Diabetes Provider Types
Provider Type
Pharmacy Retail
Primary
Diabetes Educator
Dietician
Podiatry
Ophthalmology
What providers are covered under this Provider
Type and other notes:
No data
Primary Care Physician or non-Specialist
No data
No data
No data
No data
OMB Control Numbers 1545-0047, 1210-0147, and 0938-1146
Categories
The following are the categories to use in the “Scenario” table ~ "Category" column to classify each item
and service so it rolls up to the same category in the Coverage Example label in the "Label and
Assumptions" table. This facilitates consistency between the "Scenario" table and Coverage Example
label.
Table 4. Managing Type 2 Diabetes Provider Types
Category
Over-the-counter Drugs
Medical Supplies
Prescription Drugs: Generic
Prescription Drugs: Insulin
What services are covered under this Category
and other notes:
No data
No data
No data
No data
$3.21
$3.38
Category
Diagnostic Services: Laboratory
Professional Services: Primary Care
Professional Services: Specialist
Preventive Services & Vaccines
What services are covered under this Category
and other notes:
No data
No data
No data
No data
OMB Control Numbers 1545-0047, 1210-0147, and 0938-1146
PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0938-1146. The time required to complete this
information collection is estimated to average [0.02] hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the
information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
| File Type | application/pdf |
| File Title | Managing Type 2 Diabetes Guide |
| Subject | SBC, Guide, Diabetes |
| Author | CMS |
| File Modified | 2022-05-13 |
| File Created | 2020-01-28 |