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
Providers may be eligible to dispense blood glucose testing supplies or other diabetic equipment and supplies. Eligible providers must meet criteria for third-party liability (TPL) insurance or Medicare to assist members for whom MHCP is not the primary payer.
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, A4238, A4252, A9274, A9275, E0784, E2100-E2102, S8490
MHCP covers the following equipment and supplies:
Refer to the Medical Supply Coverage Guide (PDF) for coverage information and limits on diabetic supplies not specified in this section.
Blood Glucose Monitors
Codes: E2100, E2101
Blood glucose monitors 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 stating need.
MHCP covers one blood glucose monitor per five years. Blood glucose monitors may be rented or purchased. Authorization is always required.
Blood glucose monitors with integrated voice synthesizer (E2100) are covered for members with visual impairments that affect their ability to use standard glucose monitors. Members must be able to operate this device independently.
Blood glucose monitors 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 this device independently.
Continuous Blood Glucose Monitoring (CGM)
Codes: A4238, E2102
Adjunctive continuous glucose monitors are covered for members with insulin-dependent diabetes and a history of severe hypoglycemia (less than 50 mg/dL) with unawareness due to age or cognitive function. The pharmacy or medical supplier’s office must maintain documentation including the written physician’s order stating need.
MHCP covers one monitor (E2102) or one receiver (E2102) per three years. MHCP covers one unit per month for the supplies and accessories (A4238). Adjunctive systems may be rented or purchased. Authorization is always required.
Adjunctive continuous glucose monitoring does not replace traditional home blood glucose monitoring for making treatment decisions. These devices may be authorized as a warning or alert system.
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 supply provider 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 and who demonstrate poor glycemic control despite monitoring of blood glucose levels. Insulin infusion pumps may be obtained from a medical supply provider. 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.
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 Systems
Code: A9274
External insulin infusion systems are covered for members with diabetes, who demonstrate poor glycemic control despite monitoring of blood glucose levels, and for whom insulin infusion pumps do not satisfy medical necessity. External insulin infusion systems may be obtained from a medical supply provider.
MHCP covers one external insulin infusion system per five years. External insulin infusion systems may be rented or purchased. Authorization is always required.
External insulin infusion systems are covered for members according to each device’s FDA approval criteria. 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.
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
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.
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:
For services that continue to be billed using HCPCS Level II codes, submit authorization requests to the medical review agent following instructions in the Authorization section of the MHCP Provider Manual.
For services that are part of the pharmacy Point of Sale benefit, submit authorizations to the MHCP prescription drug prior authorization agent and follow the instructions in the Drug Authorizations section of the MHCP Provider Manual.
Billing
Review the Equipment and Supplies section of the MHCP Provider Manual for billing instructions.
Report this page