Physicians, Are You Ordering Glucose Monitors and Supplies for Your Patients?

The Comprehensive Error Rate Testing (CERT) program has noted claim errors for glucose monitors and related supplies, specifically issues with orders and test strip utilization. The following information is provided to assist you in reducing these types of errors.

Medicare will consider coverage of a glucose monitor and related supplies when your patient's medical record shows they have diabetes and you have determined he/she or a caregiver is sufficiently trained to use the prescribed device appropriately. (Reference: CMS publication 100-3, Section 40.2 (PDF, 647 KB).)

Order Requirements
When ordering a blood glucose monitor for your Medicare patients, you must have a face-to-face encounter that documents an evaluation and/or treatment plan for diabetes mellitus. This encounter must take place within six months prior to ordering the glucose monitor.

The order for the glucose monitor is termed a five-element order and it must include the following:

• Patient name
• Item ordered (either a general or more specific description)
• Physician’s National Provider Identifier (NPI)
• Date of the order
• Prescribing physician’s signature

You may order diabetic testing supplies for your Medicare patients based on a dispensing order. For example, this may be from your prescription pad that reads “testing supplies for DM, test 3x/day.” The DME supplier will use that information to create a detailed written order for you to verify, sign and date. This detailed written order will include the following:

• Patient name
• Date of the order (this is the date you wrote the prescription/dispensing order)
• Description of items separately billed to Medicare (may be a narrative description, a HCPCS code, HCPCS code narrative, or brand name/model number)
• Frequency of use/testing for each item (as applicable)
• Quantity to dispense per fill
• Physician’s signature and signature date

Testing Requirements
Medicare will consider coverage for the diabetic testing regimen as outlined in the Local Coverage Determination (LCD):

For your patients who require additional testing per day, or the quantities of supplies ordered exceed Medicare’s standard utilization parameters, there are some additional documentation requirements that must be met. These are outlined in the LCD:

• Basic requirements have been met (patient has diabetes as indicated in their medical record and you have ordered a blood glucose monitor and/or related testing supplies); and
• Within the six (6) months prior to ordering quantities of strips and lancets that exceed the utilization guidelines, the treating practitioner has had an in-person visit with the beneficiary to evaluate their diabetes control and their need for the specific quantity of supplies that exceeds the usual utilization amounts described above; and
• Every six (6) months, for continued dispensing of quantities of testing supplies that exceed the usual utilization amounts, the treating practitioner must verify adherence to the high utilization testing regimen. The medical record should contain clinical rationale for excess testing as well as any changes to the diabetic treatment plan.