To be eligible for coverage of related supplies and accessories, and blood glucose monitors, the Member must comply with all the following basic criteria (1) – (4):
The patient has diabetes (See policy ICD-10 codes section) which is being treated by an endocrinologist or pediatric Endocrinologist and are 21 years old or younger; and
Glucose monitor and accessories and related supplies have been ordered by the endocrinologist or pediatric endocrinologist treating diabetes patient and the attending physician maintains records reflecting attention provided including, but not limited to, evidence that the prescribed frequency of testing is according to the patient’s condition
The patient (or the caregiver of a patient) can use the test results to ensure appropriate patient’s glycemic control. And.
The appliance is designed for household use.
If an E2100 or E2101 glucose monitor is supplied and not met the basic criteria of coverage (1) – (5), the items will be denied as not reasonable and necessary
Monitors of glucose in the blood with special features (E2100, E2101) are covered when the basic criteria of coverage (1) – (4) above and the treating physician certifies that the patient has a severe visual impairment (i.e., (best corrected visual acuity of 20/200 or worse in both eyes).
They are also covered for those patients with impaired manual dexterity when the attending physician certifies that the patient has impaired manual dexterity severe enough to require the use of the system of special monitoring.
The standard models of (E0607) home glucose monitors, defined as those that include downloadable memory functions, are covered for all patients diagnosed with diabetes type I, 21 years or less, and in compliance with the the FDA specifications.
Special guidelines for reimbursement for home and supplies glucose monitor.
