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Issue Number - Name
0152-HCPCS A4253: Blood Glucose Test or Reagent Strips
Review Type
Complex
Claim Type
DME by Supplier, DME by Physician
Region and State
RAC 5
All DME MACs
Date Approved
03/05/2019

Description

The quantity of glucose test strips (A4353) that are covered depends upon the usual medical needs of the diabetic patient. Documentation will be reviewed to determine if the utilization guidelines for blood glucose test strips (A4253) were met.

Affected Codes

HCPCS A4253: Blood Glucose Test or Reagent Strips for Home Blood Glucose Monitor, per 50 strips

Applicable Policy References

Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)-Exclusions from Coverage and Medicare as a Secondary Payer
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1833(e)-Payment of Benefits
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1834-Special Payment Rules
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1834(j)-Requirements for Suppliers of Medical Equipment and Supplies
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1842(p)(4)-Provisions Relating to the Administration of Part B
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1861(s)-Medical and Other Health Services Definitions
42 CFR, Section 405.980-Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
42 CFR, Section 405.986-Good Cause for Reopening
42 CFR, Section 424.57-Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges
42 CFR, Section 424.57(c)-Application Certification Standards
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 3-Verifying Potential Errors and Taking Corrective Actions, Section 3.2.3.8-No Response or Insufficient Response to Additional Documentation Requests
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Program Integrity, Section 4.26 Supplier Proof of Delivery Documentation Requirements Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, Section 110, Durable Medical Equipment-General
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Items and Services Having Special DME Review Considerations
CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Coverage Determinations, Section 40.2, Home Blood Glucose Monitors
CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Coverage Determinations, Section 190.20, Blood Glucose Testing
CGS Administrators LLC, and Noridian Healthcare Solutions LLC, Local Coverage Determination, L33822, Glucose Monitors, Effective Date, 10/1/2015, Revised 01/12/2017
CGS Administrators LLC, and Noridian Healthcare Solutions LLC, Local Coverage Article, A52464, Glucose Monitor, Policy Article, Effective Date, 10/01/2015, Revised 06/07/2018
CGS Administrators LLC, and Noridian Healthcare Solutions LLC, Local Coverage Article, Standard Documentation Requirements for All Claims Submitted to DME MACs, A55426, Effective 01/01/2017, Revised 08/28/2018