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Issue Number - Name
0012 - Complex Blood Glucose Monitors with Integrated Voice Synthesizer Billed Without Indicator of Medical Necessity
Review Type
Complex
Claim Type
DME Supplier
Region and State
RAC 5
All States
Date Approved
2017-05-08

Description

Medical necessity review: Medical documentation will be reviewed to determine if claims for voice synthesized blood glucose monitors were billed without an indication supporting medical necessity.

Affected Codes

  • E2100

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A)
  • Title XVIII of the Social Security Act, Section 1833(e)
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26 
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Sections 5.2.3, 5.7, 5.8 and 5.9 
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3 
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110 
  • CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 40.2 
  • LCDs, L11520, L27231, L11530, L196 (for services performed on or after 10/1/15)
  • LCD, L33822 (for services performed on or after 7/1/16)