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Printed Date: 9/22/2015
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).)
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:
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:
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:
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Last Updated: 11/19/2018