A diabetes self-management education and support (DSMES) program serves people with diabetes. To bill Medicare for the service, which CMS calls diabetes self-management training (DSMT), the program must meet the National Standards for DSMES and be accredited by a CMS-approved accrediting organization: the American Diabetes Association (ADA) or the Association of Diabetes Care & Education Specialists (ADCES). This page is for clinics, hospitals and community providers establishing DSMES and Medicare DSMT services. Integral Healthcare Solutions (IHS) builds your DSMES program documentation and accreditation evidence; your diabetes educators own the curriculum and individual plans.
Last reviewed: October 2026.
What is DSMES accreditation for Medicare DSMT?
CMS describes the service this way: "Diabetes self-management training (DSMT) is a Medicare preventive service that can result in better health for Medicare patients with diabetes" (CMS MLN909381, November 2025). The fact sheet defines who may furnish it: "A certified provider is a person or entity that meets the current National Standards for Diabetes Self-Management Education and Support (DSMES) and is accredited through a CMS-certified accrediting organization (AO)" (MLN909381). CMS names two: "We approved 2 national DSMT AOs to accredit DSMT entities: American Diabetes Association (ADA) Association of Diabetes Care & Education Specialists (ADCES)."
The governing texts:
- The 2022 National Standards for Diabetes Self-Management Education and Support. ADA states that these standards "are the framework for the 11 th Edition ADA Education Recognition application requirements" (ADA, Recognition Requirements).
- The ADA Education Recognition Program (ERP), 11th Edition requirements, or the ADCES Diabetes Education Accreditation Program (DEAP). Your organization picks one route.
- CMS MLN Fact Sheet MLN909381, "Provider Information on Medicare Diabetes Self-Management Training," November 2025, and the Medicare DSMT regulations it cites at 42 CFR 410.140 through 410.146.
Who needs it and what triggers it
The buyers are clinics, hospitals and community providers that are starting a DSMES service or want Medicare to pay for one. The triggers in the sources:
- Medicare billing. Only a certified provider, meaning one that meets the National Standards and holds accreditation from ADA or ADCES, furnishes DSMT under Medicare (MLN909381).
- A program that is ready to apply. ADA's first criterion is that "The DSME program must have fully implemented the National Standards for Diabetes Self-Management Education and Support" (ADA, First Steps).
- Setting. "Eligibility for ADA Recognition status is only for diabetes education services in the non-acute setting, including Licensed Home Health agencies" (ADA).
- Recognition ending. ADA recognition and ADCES accreditation each run for 4 years (MLN909381).
How IHS helps
You choose the ADA or ADCES route. IHS then works through it with your team:
- A gap assessment against that route's requirements, the National Standards for DSMES and the Medicare DSMT rules, using questionnaires on referrals and educators.
- Evidence mapping: a crosswalk from each requirement to the record that shows you meet it.
- Drafted referral, documentation, educator qualification and quality-review procedures, which your diabetes educators and program leadership review and approve.
- A mock file review of participant records against the requirements before the application goes in.
- Readiness support: drafted application text for your organization to file.
What you supply: educator credentials, your curriculum, participant records, and your educators' approval of the documents IHS drafts.
The limit: curriculum content and individual education plans are the diabetes educators' work. IHS does not write them and does not file with ADA, ADCES or CMS. Your organization does.
For people with prediabetes rather than diagnosed diabetes, see CDC diabetes prevention recognition and MDPP supplier readiness.
What to have ready
This is the list we would ask for first, each item tied to the text that requires it.
- A choice of accrediting organization, ADA or ADCES (MLN909381, November 2025).
- Evidence that the program has "fully implemented" the National Standards for DSMES (ADA, First Steps).
- Confirmation that services run in a non-acute setting, if you apply to ADA (ADA, 11th Edition requirements).
- At least two outcomes you track: "At least 2 outcomes must be tracked* as a measure of service success" (ADA).
- A reporting period for an original application, which "can start up to 6 months prior to the online application submission date and be 1 month up to 6 months in length" (ADA).
- Referral records showing the order came from "the physician, nurse practitioner (NP), physician assistant (PA), or certified nurse specialist (CNS) who's treating the patient for diabetes" (MLN909381).
- A scheduling check, because "You can't provide DSMT and medical nutrition therapy (MNT) to the same patient on the same service date" (MLN909381).
- A process to "collect and record this patient assessment information at least quarterly according to requirements in 42 CFR 410.146" (MLN909381).
- Records kept so they can be produced for a random virtual audit by ADA or ADCES (MLN909381).
If most of this is in place, the introductory call is the place to start.
How it compares
| Route or benefit | What the sources say |
|---|---|
| ADA Education Recognition Program | CMS reports that "The ERP reviews the application in less than 30 days" and then notifies the entity that "it's approved for a 4-year recognition period" or that more information is needed. ADA "conducts random virtual audits for less than 5% of all recognized programs, with a maximum of 70 audits each year" (MLN909381). Eligibility is limited to non-acute settings (ADA). |
| ADCES Diabetes Education Accreditation Program | "Approved programs are accredited for 4 years." ADCES "performs random virtual audits of about 5% of all accredited programs, with a minimum of 44 and a maximum of 70 audits each year" (MLN909381). |
| Medical nutrition therapy (MNT) | A separate Medicare benefit. DSMT and MNT cannot be provided to the same patient on the same service date (MLN909381). |
| National DPP and Medicare MDPP | A CDC-recognized lifestyle change program for diabetes prevention, with Medicare enrollment under 42 CFR 424.205. IHS's reading, as of October 2026, is that it serves people with prediabetes while DSMES serves people already diagnosed; that reading comes from the two programs' eligibility, not from a single source. |
Both accrediting organizations are named by CMS. This page does not recommend one over the other.
What it costs
ADA publishes its Education Recognition fees: "For a 4-year Recognition cycle: Original (in person) $1,100 for the main site. $100 for each additional multi-site." ADA adds that "There is no fee for expansion sites" and that programs providing DSMES virtually should "contact ERP staff for different pricing models" (ADA, First Steps). Verify current fees with ADA.
ADCES's fee information was not available to us for this page, so verify current fees with ADCES.
IHS scopes each engagement after a free introductory call.
What this is not
- IHS is not an accrediting organization and does not grant, influence or predict an ADA or ADCES decision.
- IHS does not submit applications to ADA, ADCES or CMS or correspond with them on your behalf. IHS drafts; your organization submits.
- This page is not legal or billing advice, and IHS does not write curriculum or individual education plans.
Frequently asked questions
What is the difference between DSMES and Medicare DSMT?
DSMT is the name CMS uses for the Medicare preventive service. CMS defines a certified DSMT provider as one that meets the current National Standards for DSMES and is accredited through a CMS-certified accrediting organization.
Does our program need ADA recognition or ADCES accreditation to bill Medicare for DSMT?
Yes. CMS fact sheet MLN909381 says a certified provider is accredited through a CMS-certified accrediting organization, and CMS has approved two: the American Diabetes Association and the Association of Diabetes Care & Education Specialists.
ADA Education Recognition Program or ADCES DEAP: how do they differ?
Both are CMS-approved and both run on a 4-year cycle. CMS reports that ADA reviews applications in less than 30 days and audits fewer than 5% of recognized programs a year, while ADCES audits about 5% of accredited programs, between 44 and 70 a year. ADA recognition is limited to non-acute settings, including licensed home health agencies.
What must a DSMES program have in place before applying for ADA recognition?
ADA's first criterion is that the program has fully implemented the National Standards for Diabetes Self-Management Education and Support. The 11th Edition requirements also call for at least two tracked outcomes and a reporting period of 1 to 6 months for an original application.
How long does ADA take to review an application, and how long does recognition last?
According to CMS fact sheet MLN909381, the ERP reviews the application in less than 30 days and then either approves a 4-year recognition period or asks for more information.
How much does ADA Education Recognition cost?
ADA lists $1,100 for the main site for an original in-person application over a 4-year cycle, plus $100 for each additional multi-site, with no fee for expansion sites. Virtual programs are asked to contact ERP staff for pricing. Verify current fees with ADA.
What patient data does Medicare require a DSMT program to collect, and how often?
CMS requires an approved entity to collect and record patient assessment information at least quarterly, according to 42 CFR 410.146. IHS drafts the documentation procedure and calendar; your educators collect the data.
Who can refer a Medicare patient to DSMT?
The physician, nurse practitioner, physician assistant or certified nurse specialist who is treating the patient for diabetes. CMS also states that DSMT and medical nutrition therapy cannot be provided to the same patient on the same service date.
How often do ADA and ADCES audit programs?
CMS reports that ADA conducts random virtual audits of less than 5% of recognized programs, up to 70 a year, and ADCES audits about 5% of accredited programs, from 44 to 70 a year. Records kept to the requirements throughout the cycle are what an audit draws on.
What outcomes must a DSMES service track for ADA recognition?
ADA's 11th Edition requirements state that at least 2 outcomes must be tracked as a measure of service success. Which outcomes you track is a decision for your educators and program leadership.