Glucose Monitors

The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.

Coverage

Glucose Monitors and Testing Supplies Local Coverage Determination (LCD) and Policy Article [PDF]
Home Blood Glucose Monitors National Coverage Determination (NCD)

Documentation

Clinician Documentation Requirements - Blood Glucose Strips and Lancets [PDF] - Letter may be used as communication tool between suppliers and clinicians to ensure documentation compliance for DMEPOS claims and audits
Clinician Letter - Continued Medical Necessity [PDF] - Clinician directed letter that reminds them that ongoing need for and use of DMEPOS item must be documented in patient's medical record
Clinician Letter - Home Blood Glucose Monitor (BGM) [PDF] - Clinician directed letter that advises them as to what type of documentation is necessary in medical records to support payment of glucose monitors and related supplies
Clinician Letter - Therapeutic Continuous Glucose Monitor (CGM) [PDF] - Clinician directed letter that advises them as to what type of documentation is necessary in medical records to support payment of glucose monitors and related supplies
Glucose Monitors and Related Supplies Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
Patient Documentation Form - Insulin Using [PDF] - Patients using insulin may bring this letter to clinicians to help them in medical record documentation
Patient Documentation Form - Non-Insulin Using [PDF] - Patients not using insulin may bring this letter to clinicians to help them in medical record documentation

Reviews/Audits

Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Tips

Topic	Details
Diabetic Supplies and Accessories Used with CGM	Must be billed to the DME MAC with HCPCS K0553. The supply allowance includes all items necessary for the use of the device and includes, but is not limited to: CGM sensor, CGM transmitter, home BGM and related BGM supplies (test strips, lancets, lancing device, calibration solutions) and batteries. One unit of service equals a one-month supply to be used with the CGM. These supplies shall not be billed individually or with a National Drug Code (NDC). Suppliers should work with their billing/software vendors to ensure individual supplies/codes are consolidated into HCPCS K0553. See CMS Medicare Learning Network (MLN) Matters (MM)10013 for details.

Topic

Details

Diabetic Supplies and Accessories Used with CGM

Must be billed to the DME MAC with HCPCS K0553. The supply allowance includes all items necessary for the use of the device and includes, but is not limited to: CGM sensor, CGM transmitter, home BGM and related BGM supplies (test strips, lancets, lancing device, calibration solutions) and batteries. One unit of service equals a one-month supply to be used with the CGM. These supplies shall not be billed individually or with a National Drug Code (NDC). Suppliers should work with their billing/software vendors to ensure individual supplies/codes are consolidated into HCPCS K0553. See CMS Medicare Learning Network (MLN) Matters (MM)10013 for details.

Last Updated Jan 10, 2020

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.