by Medicare Learning Network
March 8th, 2018
The Medicare Learning Network provides guidance and required documentation to Prevent Denials for Home Blood Glucose Monitors (BGM):
To be eligible for coverage of home blood glucose monitors and related accessories and supplies, the beneficiary must meet both of the following basic criteria:
1. The beneficiary has diabetes (Reference the ICD-10 Codes that Support Medical Necessity section for applicable diagnoses in LCD L33822)
2. The beneficiary’s physician concludes that the beneficiary (or the beneficiary’s caregiver) has sufficient training using the particular device prescribed as shown by providing a prescription for the appropriate supplies and frequency of blood glucose testing
|For all glucose monitors and related accessories and supplies, if the basic coverage criteria (items 1 and 2 above) are not met, the item(s) will be denied as not reasonable and necessary.|
When Medicare covers a glucose monitor, for a beneficiary, then lancets (code A4259), blood glucose test reagent strips (code A4253), glucose control solutions (code A4256) and spring powered devices for lancets (code A4258) are also covered.
The quantity of test strips (code A4253) and lancets (code A4259) that are covered depends on the usual medical needs of their beneficiary and whether or not the beneficiary is being treated with insulin, regardless of their diagnostic classification as having Type 1 or Type 2 diabetes mellitus. Refer to (LCD L33822) for coverage guidelines for these items.