As the Medicare Coverage Policy is the industry standard, your other insurance coverage is most likely, to some extent, the same. Therefore, you can use these as guidelines. For actual coverage information you must contact your insurance company directly - or let us do it for you!

Note: Monthly allowable amounts do not represent a benefit limit. The actual quantity needed by a particular customer may be more or less than the amount listed, depending on the individual customer's medical condition. Customers ordering over the allowable amount must have appropriate medical justification, including a one-month log of all blood glucose readings.

1. Medicare reimbursement limits Diabetic Testing Supplies to a 3 months supply at one time.
2. If treatment regimen exceeds the quantity limitations noted below, then Medicare requires a Letter of Medical Necessity signed by the physician on his or her letterhead.
3. If you fax this document, Medicare/insurance requirements are that you maintain the signed original in the patient's medical record for post-payment review audit purposes.
4. Home blood glucose monitors are covered for patients who are diabetics and who can better control their blood glucose levels by checking these levels and appropriately contacting their attending physician for advice and treatment.
5. To be eligible for coverage, the patient must meet all of the following basic criteria:
   1. The patient has diabetes (ICD-9 codes 250.00-250.93) which is being treated by a physician; and
   2. The glucose monitor and related accessories and supplies have been ordered by the physician who is treating the patient's diabetes and the treating physician maintains records reflecting the care provided including, but not limited to, evidence of medical necessity for the prescribed frequency of testing; and
   3. The patient (or the patient's caregiver) has successfully completed training or is scheduled to begin training in the use of the monitor, test strips, and lancing devices; and
   4. The patient (or the patient's caregiver) is capable of using the test results to assure the patient's appropriate glycemic control; and
   5. The device is designed for home use.
6. Home blood glucose monitors with special features (i.e. Blood Glucose Monitor with integrated voice synthesizer or Blood Glucose Monitor with integrated lancing device/blood sample (E2100, E2101)) are covered when the basic coverage criteria (1)-(5) are met and the treating physician certifies that the patient has a severe visual impairment (i.e., best corrected visual acuity of 20/200 or worse) requiring use of this special monitoring system.
7. A Blood Glucose Monitor with integrated lancing device/blood sample (E2101) is also covered for those with impairment of manual dexterity when the basic coverage criteria (1)-(5) are met and the treating physician certifies that the patient has an impairment of manual dexterity severe enough to require the use of this special monitoring system. Coverage of E2101 for patients with manual dexterity impairments is not dependent upon a visual impairment.
8. Lancets (A4259), blood glucose test reagent strips (A4253), glucose control solutions (A4256), spring powered devices for lancets (A4258) are covered for patients for whom the glucose monitor is covered. More than one spring powered lancing device (A4258) per 6 months will rarely be medically necessary.
9. Laser skin piercing devices (E0620) and their necessary replacement lens shield cartridges (A4257) are not covered.
10. The quantity of test strips (A4253), lancets (A4259), and replacement lens shield cartridges (A4257) that are covered depends on the usual medical needs of the diabetic patient according to the following guidelines:
    1. For a patient who is not currently being treated with insulin injections, up to 100 test strips and up to 100 lancets every 3 months are covered if criteria (a)-(c) are met:
    2. For a patient who is currently being treated with insulin injections, up to 100 test strips and up to 100 lancets every month are covered if criteria (a)-(c) are met:
    3. For a patient who is not currently being treated with insulin injections, more than 100 test strips and more than 100 lancets every 3 months are covered if criteria (a)-(f) are met:
    4. For a patient who is currently being treated with insulin injections, more than 100 test strips and more than 100 lancets or one lens shield cartridge every month are covered if criteria (a)-(f) are met:
       1. Coverage criteria (1)-(5) listed above for a glucose monitor are met.
       2. The supplier of the test strips and lancets, or lens shield cartridge maintains in its records the order from the treating physician.
       3. The beneficiary has nearly exhausted the supply of test strips and lancets, or useful life of one lens shield cartridge previously dispensed.
       4. The treating physician has ordered a frequency of testing that exceeds the utilization guidelines and has documented in the patient's medical record the specific reason for the additional materials for that particular patient.
       5. The treating physician has seen the patient 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.