Program_Memos / 2000 / AB-00-108

Why This Topic Matters

The memorandum clarifies how Medicare treats glucose monitoring across multiple care settings and how payment is handled under the laboratory fee schedule. It is important for determining whether claims fit the applicable coverage framework and for understanding the timing and implementation of fee schedule updates.

Article Sections

1. Overview

   Introduces the Medicare policy review and the general setting in which glucose monitoring services are discussed. Summarizes the reason the memorandum was issued and the broader administrative context.

2. Glucose monitoring service and coverage background

   Describes the service at a high level and discusses the medical, laboratory, and regulatory background relevant to coverage. References federal requirements, laboratory supervision concepts, and prior policy developments.

3. Hospital and skilled nursing facility payment guidance

   Addresses how the service is handled when a beneficiary is in hospital or skilled nursing facility settings under Part B. Includes billing, revenue coding, and related payment considerations in those settings.

4. Home health payment guidance

   Discusses the service in the home health setting and how it interacts with home health benefit rules. Covers when the service is included in the benefit and when separate laboratory payment is considered.

5. Separate quantitative glucose testing

   Distinguishes the home-use monitoring service from another type of glucose laboratory test ordered in connection with evaluation and management care. Notes where related fee schedule instructions are found.

6. Clinical laboratory fee schedule and gap-filling

   Explains the fee schedule status of the laboratory service and the need for carrier gap-filling for the referenced year. Discusses how the local fee amount is established and used for later national pricing.

7. Effective date and administrative notes

   Provides the effective and implementation dates and final administrative instructions for handling claims and inquiries. Includes the retention period and contact information.