NEWS
For any item to be covered by insurance carrier, it must 1) be eligible for a defined benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable insurance statutory and regulatory requirements. For the items addressed in your medical policy, the criteria for "reasonable and necessary" are defined by the following indications and limitations of coverage and/or medical necessity.
1. The patient has diabetes (ICD-9 codes 249.00-250.93) which is being treated by a physician; and
2. The glucose monitor and related accessories and supplies have been ordered by the physician who is treating the
patient's diabetes and the treating physician maintains records reflecting the care provided including, but not limited to, evidence of medical necessity for the prescribed frequency of testing; and
3. The patient (or the patient's caregiver) has successfully completed training or is scheduled to begin training in the use of the monitor, test strips, and lancing devices; and
4. The patient (or the patient's caregiver) is capable of using the test results to assure the patient's appropriate glycemic control; and
5. The device is designed for home use.
ABOUT COVERAGE
Test Strips & Lancets
Diabetic Shoes
Cool Pack Supply Carrier
Skin Prep
Monitor
For an item to be covered by insurance carrier, a written signed and dated order must be received by the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving the completed order, the item will be denied as not medically necessary.
To be eligible for coverage of home blood glucose monitors and related accessories and supplies, the patient must meet all of the following basic criteria:
If you use insulin
Test Strips
100 per month
Lancets
100 per month
Lancet Device
1 every 6 months
If you do not use insulin
Test Strips
100 every 3 months
Lancets
100 every 3 months
Lancet Device
1 every 6 months
