Diabetic Supplies and Correct Units of Service

Original Effective Date: 04/01/2000
Revision Effective Date: 11/01/2013

An examination of claims for diabetic supplies shows common billing errors on the number of services for lancets and strips. This article addresses billing errors we see frequently.

1. Suppliers providing the same number of strips as lancets are billing the same units of service for both, even though codes A4253 and A4259 represent different numbers of items.

Resolution. One unit of service for code A4253 represents 50 test strips for a blood glucose monitor, while one unit of service for code A4259 represents 100 lancets. Use caution when entering the numbers of services on these claims. For example, if 200 strips and 200 lancets are provided, the supplier should bill A4253 with 4 units of service, and A4259 with 2 units of service.

Item Provided: 200 strips Code: A4253 Correct Units of Services: 4
Item Provided: 200 lancets Code: A4259 Correct Units of Services: 2

2. The number of days the strips are for (e.g., 30) or the number of individual strips supplied (e.g., 50) is entered in Item 24G of the HCFA-1500 claim form.

Resolution. The correct number of units as defined above must be entered into Item 24G of the claim form. This field should not be used to enter a number of days or the number of individual strips.

3. Some units of service are billed with added zeroes. For example, "020" is entered in Item 24G for 2 units of service. We read this as "20" units of service instead of "2."

Resolution. To bill the correct units of service, enter and submit the actual number of units; do not add zero.

            Last Updated Wed, 10 May 2017 09:47:10 +0000