Diabetic Equipment and Supplies
Overview
Diabetic equipment and supplies are used to monitor and control blood glucose levels.
Point of Sale Diabetic Testing Supply Program
The following supplies are included in the point-of-sale diabetic testing supply program:
These are only covered as a durable medical equipment benefit when billed as a Medicare crossover claim.
Refer to Point of Sale Diabetic Testing Supply Program in the Pharmacy Services section of the Minnesota Health Care Programs (MHCP) Provider Manual for more information.
Eligible Providers
The following may provide diabetic equipment and supplies:
Third-Party Liability (TPL) and Medicare
Providers must meet any provider criteria, including accreditation, for third-party insurance or for Medicare to assist members for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested. Refer to the Medicare and Other Insurance section of the MHCP Provider Manual for more information.
Eligible Members
Diabetic equipment and supplies are covered for eligible Medical Assistance and MinnesotaCare members with diabetes or related conditions who meet criteria for the specific device as described under the Covered Services heading.
Covered Services
Codes: A4211 U3, A4224, A4225, A4230-A4238, A4250, A4252, A9274, A9275, E0784, E2100-E2102, S8490
MHCP covers the following diabetic equipment and supplies:
Members must be treated by an endocrinologist or provider who has specific training and experience in managing diabetes.
Diabetic equipment and supplies are included in the per diem for members living in a nursing facility. Almost all diabetic equipment and supplies are included in the per diem for members living in an intermediate care facility for people with developmental disabilities (ICF/DD).
Refer to the Medical Supply Coverage Guide (PDF) for coverage information and limits on diabetic supplies not specified in this section.
Blood Glucose Monitors with Integrated Features
Codes: E2100, E2101
Blood glucose monitors (BGMs) with integrated features are covered for members with diagnoses that require regular monitoring of blood glucose levels. The pharmacy or medical supplier’s office must maintain documentation including the written physician’s order documenting medical necessity. Authorization is not required, except for excess quantities.
MHCP covers BGMs with integrated voice synthesizer (E2100) and blood sample (E2101) features. MHCP covers one BGM with integrated features per five years.
BGMs with integrated features may be rented or purchased. BGMs with integrated features may be obtained from a medical supplier or pharmacy.
BGMs with integrated voice synthesizers (E2100) are covered for members with visual impairments that affect their ability to use standard glucose monitors.
BGMs with integrated lancing/blood sample (E2101) are covered for members with deficits to dexterity that affect their ability to use standard glucose monitors.
Members must be able to operate devices with integrated features independently. Dispensing of BGMs includes education on use of the equipment.
Continuous Blood Glucose Monitors
Codes: A4238, E2102
Continuous blood glucose monitors (CGMs) are devices that measure blood glucose levels received from interstitial fluid continuously throughout the day and night. The CGM provides the member with readings of blood glucose levels by recording data in real time.
CGMs are covered if the following criteria are met:
The member must be treated by a provider who has specific training and experience in managing diabetes. The pharmacy or medical supplier’s office must maintain documentation including the written physician’s order stating need. Authorization is not required, except for excess quantities.
The CGM is composed of a disposable sensor, the transmitter, and a monitor or receiver. HCPCS code E2102 describes the monitor or receiver. MHCP covers one monitor or one receiver per three years. HCPCS code A4238 describes the sensor, transmitter, and all other accessories required for device functioning. MHCP covers one unit per month for supplies described by HCPCS code A4238. Adjunctive systems may be rented or purchased.
The CGM may be adjunctive or nonadjunctive. Adjunctive systems do not replace traditional home blood glucose monitoring for making treatment decisions. Nonadjunctive systems are described by HCPCS code E2103 and are covered under the Point of Sale Diabetic Testing Supply Program.
Adjunctive systems must be coded based on Medicare’s Pricing, Data Analysis and Coding for durable medical equipment. Refer to the Palmetto Durable Medical Equipment Coding System webpage for more information.
Disposable Blood Glucose Monitors
Code: A9275
Disposable blood glucose monitors are covered for members with diabetes. Disposable blood glucose monitors may be obtained from a medical supplier or pharmacy. Members who require testing more frequently than is possible with four disposable meters per month may use a traditional meter and test strips.
MHCP covers four disposable blood glucose meters per month. Authorization is not required, except for excess quantities.
Disposable blood glucose meters include any necessary test strips and calibration solution or chips. Blood glucose test strips may not be billed within 30 days of disposable blood glucose meters.
Bill one unit per meter with test strips. Submit a claim with an attachment that includes the name of the product dispensed and required documentation for manual pricing. Review Billing Policy in the Equipment and Supplies section of the MHCP Provider Manual for documentation requirements.
Blood Ketone Test Strips
Code: A4252
Blood ketone test strips are covered for members with diabetes and are at risk of ketoacidosis for whom urine ketone testing is not sufficient or for members on a medically supervised ketogenic diet for intractable seizures. Blood ketone test strips may be obtained from a medical supply provider or pharmacy. Authorization is always required.
Documentation must include:
Members must have a blood glucose monitor capable of blood ketone testing. If the member has a blood glucose monitor that is less than five years old, providers must submit a claim with an attachment explaining the need for the replacement monitor with the approved authorization for the blood ketone test strips in the notes field.
Insulin Syringes
Code: S8490
Insulin syringes are covered for members with diabetes. MHCP covers up to 300 insulin syringes per month. Insulin syringes may be obtained from a medical supply provider or pharmacy. Authorization is not required, except for excess quantities.
Insulin Infusion Pumps
Code: E0784
Insulin infusion pumps are covered for members with insulin-dependent diabetes mellitus and who demonstrate poor glycemic control despite monitoring of blood glucose levels. Authorization is not required, except for excess quantities.
Insulin infusion pumps are covered for diabetic members if the following criteria are met:
MHCP covers one insulin infusion pump per five years. Insulin infusion pumps may be rented or purchased. Insulin infusion pumps may be obtained from a medical supply provider.
The member must be treated by a provider who has specific training and experience in managing diabetes. The medical supplier’s office must maintain documentation including the written physician’s order stating need.
Providers must attest that c-peptide testing is conducted according to current standards of care, when applicable.
Documentation for replacement pumps must include the date the current pump’s warranty expires and the reason for replacement.
External Insulin Infusion Pumps
Code: A4224, A4225, A4230-A4232, A9274
External insulin infusion pumps are covered for members with insulin-dependent diabetes mellitus, who demonstrate poor glycemic control despite monitoring of blood glucose levels, and for whom insulin infusion pumps do not satisfy medical necessity. Authorization is always required.
HCPCS code A9274 describes the disposable and external delivery system. MHCP covers 10 units per month. Most members can be served with 10 units per month. Additional quantities may be requested for members who require more frequent administration of insulin.
Members must meet the criteria under insulin infusion pumps. Documentation must articulate why insulin infusion pumps do not suffice for medical necessity and why the tubeless option is required.
External insulin infusion pumps are purchase items only. External insulin infusion pumps may be obtained from a medical supply provider.
External insulin infusion pumps are covered for members according to each device’s FDA approval criteria.
Supplies for external insulin infusion pumps, including insulin infusion catheters (A4224), syringe type reservoirs (A4225), infusion sets (A4230, A4231), and syringes (A4232), are covered for members who are authorized pumps. HCPCS code A4224 is all-inclusive of supplies required for external insulin infusion systems, except for syringe type reservoirs (A4225). HCPCS code A4224 includes cannulas, dressings, needles, and infusion supplies.
Sharps Disposal Containers
Code: A4211 U3
Sharps disposal containers are covered for members who self-administer medications using syringes. Providers must use HCPCS code A4211 and modifier U3 along with appropriate pricing information as outlined under Billing Policy in the Equipment and Supplies section of the MHCP Provider Manual. Submit a pricing attachment for all claims. When billing for members with Medicare, include an attachment that clearly states “sharps container not covered by Medicare” or add this statement under claim note field in MN–ITS.
Miscellaneous Diabetic Supplies
Urine test or reagent strips or tablets (A4250) are covered for diabetic members who choose not to use blood glucose monitoring or for diabetic members at risk of ketoacidosis.
Replacement batteries (A4233 through A4236) are covered for member-owned blood glucose monitors when the original item no longer functions.
Noncovered Services
The following supplies are not covered under this durable medical equipment policy but are covered in the Point of Sale Diabetic Testing Supply Program (unless the member has Medicare Part B):
Refer to the Pharmacy Services section of the MHCP Provider Manual for additional information.
Authorization
Authorization is required for the following:
Submit authorization requests for services that continue to be billed using HCPCS Level II codes to the medical review agent following instructions in the Authorization section of the MHCP Provider Manual.
Submit authorizations for services that are part of the pharmacy Point of Sale benefit to the MHCP prescription drug prior authorization agent and follow the instructions in the Drug Authorizations section of the MHCP Provider Manual.
BGMs with integrated features (E2100, E2101) and CGMs (E2102) always required authorization through dates of service ending Oct. 31, 2026.
Billing
Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of the MHCP Provider Manual for general billing information.
Bill diabetic equipment and supplies using MN–ITS 837P Professional. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics, Orthotics, and Augmentative Devices MN–ITS user manual for general billing requirements and guidance when submitting claims.
Shipping and delivery costs are included in the MHCP maximum allowable payment. Do not bill either MHCP or the member separately for these costs.
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