Medicare Guidelines for
Diabetic Testing Supplies

Sample "Ideal" Prescription for Medicare

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Medicare does not consider a home glucose monitor and testing supplies necessary unless the patient's diagnosis is diabetic. The diagnosis must be specific, and the pharmacy must have the ICD-9 diagnosis code or description on the prescription. The ICD-9 diagnosis code is preferred. Prior to July 1, 2005, you were required to obtain a new script at least every 12 months. However, for service dates on or after July 1, 2005, a new script is only required when there is a change in the frequency of testing, or when there is a new supplier.

Monitors with voice synthesizers are covered for patients with bilateral, best-corrected visual acuity of 20/200 or worse.

Usual Quantities of Testing Supplies
The following amounts of supplies are covered as a Medicare usual guideline depending on whether or not the patient is insulin treated:

Non-insulin treated: Up to 100 lancets and 100 test strips every 3 months.

Insulin Treated: Up to 100 lancets and 100 test strips every 1 month.


 

 

Physician Requirements:
The pharmacy must receive a written prescription from the physician before they may submit claims to Medicare for reimbursement. The prescription should include an accurate ICD-9 diagnosis code or description, whether or not the patient is using insulin injections, and list the ordered items and frequency of testing.
Prescriptions for diabetic supplies must be renewed if the frequency in testing has changed or if there is a new supplier.
Renewal prescriptions must contain the same information as initial prescription, and must be submitted to the pharmacy using one of the methods acceptable for initial prescriptions.
CMS (Centers for Medicare and Medicaid Services) expects that physician records will reflect the care provided to the patient including, but not limited to, evidence of the medical necessity for the prescribed frequency of testing. Physicians are not required to fill out additional forms from pharmacies or to provide additional information to pharmacies unless specifically requested of the pharmacy, by the DMERC (Durable Medical Equipment Regional Carriers).
Claims billed to Medicare for diabetic testing supplies must be supported by a valid prescription. The prescription may be in the form of a written, a fax, or an electronic order, and must state to the pharmacy:

1 The item(s) to be dispensed
2 The quantity of item(s) to be dispensed
3 The frequency of testing ("AS NEEDED" is not acceptable)
4 Whether the patient has insulin-treated or non-insulin-treated diabetes
5 The ordering physician signature
6 The signature date