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CGS Administrators, LLC

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August 31, 2016

Physicians! Are You Ordering Glucose Monitors and Supplies For Your Patient?

Medicare will consider coverage of a glucose monitor and related supplies when the patient's medical record shows the patient has diabetes and you have determined he/she or a caregiver is sufficiently trained to use the prescribed device appropriately.  CMS publication 100-3, Section 40.2External PDF
For the glucose monitor only, the following is required prior to delivery:

Glucose Monitor
Documentation prior to delivery

  Glucose Monitor
Prescription prior to delivery

A face to face visit within six months prior to prescribing

  • Documenting the patient was evaluated and/or treated for diabetes mellitus supporting need for the item(s) ordered

A five element order with the following:  

  • Patient name
  • Item ordered
  • National Provider Identifier (NPI)
  • Date of the order
  • Prescribing practitioner signature

For any item provided based on physician contact with a DME supplier to provide the service (i.e., dispensing order), the supplier must obtain a detailed written order before submitting a claim. The detailed written order must contain:

Detailed Written Order Elements (DWO) prior to billing

 Items provided on periodic basis, test strips and lancets DWO must include

Beneficiary's name

Item(s) to be dispensed

Prescribing practitioner’s name

Frequency of use/testing frequency  

Date of the order

Quantity to be dispensed

Detailed description of the item(s)

Number of refills

Prescribing practitioner’s signature and signature date

 

The DME MAC Glucose Monitors Local Coverage Determination (LCD) L33822 defines the quantity of test strips and lancets that are covered when the basic coverage criteria are met as follows:

Treatment
Regimen

Basic Coverage
Test Strips and Lancets

Prescribed Testing
Frequency

Insulin treated

300 per 3 months

3 times a day

Non-insulin treated

100 per 3 months

Once a day

Additional criteria must be met, documented in your patient’s medical record, and made available to the supplier (or review contractor) upon request when quantities of supplies ordered exceed utilization parameters indicated above. These additional documentation requirements are:
EXTRA SPACE

 Overutilization Documentation

  • Physician has seen and evaluated the beneficiary’s diabetes within six months of ordering quantities of supplies above the normal utilization and has documented in the medical record the specific reason for the additional supplies  
  • Medical records documenting frequency of actual testing by beneficiary
  • Specific narrative that documents frequency beneficiary is actually testing; or,
  • Copy of the beneficiary’s testing log (must be provided to physician by beneficiary)

 

Following this guidance will help your patients and the Medicare program by verifying that there is medical documentation to support the provision of a glucose monitor and supplies, allow your patient to receive the items needed to treat their condition, and allow Medicare to pay claims appropriately.         
Local Coverage Determinations for Glucose Monitors and Supplies
Jurisdiction A - https://med.noridianmedicare.com/web/jadme/policies/lcd/active
Jurisdiction B - http://www.cgsmedicare.com/jb/coverage/lcdinfo.html
Jurisdiction C - http://www.cgsmedicare.com/jc/coverage/lcdinfo.html 
Jurisdiction D - https://med.noridianmedicare.com/web/jddme/policies/lcd/active

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