Reminder - National Mail Order Suppliers and Testing Supplies

Posted November 15, 2013

Suppliers selected for national mail order of diabetic testing supplies are reminded of the following regulations governing the provision of testing supplies:

• Contract suppliers for diabetic testing supplies must furnish the brand of diabetic testing supplies that work with the home blood glucose monitor selected by the beneficiary. The contract supplier is prohibited from influencing or incentivizing the beneficiary by persuading, pressuring, or advising them to switch from their current brand or for new beneficiaries from their preferred brand of glucose monitor and testing supplies. The contract supplier may not furnish information about alternative brands to the beneficiary unless the beneficiary requests such information. [Emphasis added - See 42 CFR 414.422(e)(3)]

• Physicians have the option of prescribing a specific brand of glucose monitor if the physician determines that the particular brand or mode of delivery would avoid an adverse medical outcome for the beneficiary. If the physician prescribes a specific brand of monitor, the supplier has three (3) options:

(1) Furnish the particular brand or mode of delivery as prescribed by the physician or treating practitioner; or,

(2) Consult with the physician or treating practitioner to find an appropriate alternative brand of item or mode of delivery for the beneficiary and obtain a revised written prescription from the physician or treating practitioner; or

(3) Assist the beneficiary in locating a contract supplier that can furnish the particular brand.

(See 42 CFR 414.420)

CMS and the DME MACs are monitoring utilization data and will refer to the appropriate contractor(s) for further investigation any National Mail Order supplier who is suspected of violating these and other terms of their contract.

Glucose monitors are covered under the Durable Medical Equipment benefit; therefore, the 5-year reasonable useful lifetime (RUL) rules apply. Additional information on RUL and replacement of DME may be found in the Medicare Benefit Policy Manual (Internet-only Manual, Publ. 100-2), Chapter 15, §110.2. Routine replacement or replacement due to a change in suppliers is non-covered by Medicare.

Last Updated May 26 , 2017