Article Detail - JD DME

Posted December 28, 2012

Recently the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) published a revised local coverage determination (LCD) for Glucose Monitors and Supplies. Language was inadvertently omitted from the Indications and Limitations of Coverage and/or Medical Necessity section. Specifically, the previous policy in criteria d and e stated:

d. The treating physician has ordered a frequency of testing that exceeds the utilization guidelines and has documented in the beneficiary's medical record the specific reason for the additional materials for that particular beneficiary.

e. The treating physician has seen the beneficiary and has evaluated their diabetes control within 6 months prior to ordering quantities of strips and lancets, or lens shield cartridges that exceed the utilization guidelines.

The statement in criterion d regarding documentation in the beneficiary's medical record describing the specific reason(s) for the additional supplies was inadvertently omitted from the revised and consolidated coverage criteria in the LCD effective 11/01/2012. The LCD is being republished with the language reinstated in criteria b. Criterion b now reads:

b. The treating physician has seen the beneficiary, evaluated their diabetes control within 6 months prior to ordering quantities of strips and lancets that exceed the utilization guidelines and has documented in the beneficiary's medical record the specific reason for the additional materials for that particular beneficiary; and,

The DME MACs are issuing this corrected LCD with the effective date unchanged. We apologize for the omission.