CMS Pub. 100-03, ch. 1, § 40.2

CIM 60-11

There are several different types of blood glucose monitors that use reflectance meters to

determine blood glucose levels. Medicare coverage of these devices varies, with respect

to both the type of device and the medical condition of the patient for whom the device is

prescribed.

Reflectance colorimeter devices used for measuring blood glucose levels in clinical

settings are not covered as durable medical equipment for use in the home because their

need for frequent professional re-calibration makes them unsuitable for home use.

However, some types of blood glucose monitors which use a reflectance meter

specifically designed for home use by diabetic patients may be covered as durable

medical equipment, subject to the conditions and limitations described below.

Blood glucose monitors are meter devices that read color changes produced on specially

treated reagent strips by glucose concentrations in the patient’s blood. The patient, using

a disposable sterile lancet, draws a drop of blood, places it on a reagent strip and,

following instructions which may vary with the device used, inserts it into the device to

obtain a reading. Lancets, reagent strips, and other supplies necessary for the proper

functioning of the device are also covered for patients for whom the device is indicated.

Home blood glucose monitors enable certain patients to better control their blood glucose

levels by frequently checking and appropriately contacting their attending physician for

advice and treatment. Studies indicate that the patient’s ability to carefully follow proper

procedures is critical to obtaining satisfactory results with these devices. In addition, the

cost of the devices, with their supplies, limits economical use to patients who must make

frequent checks of their blood glucose levels. Accordingly, coverage of home blood

glucose monitors is limited to patients meeting the following conditions:

1. The patient has been diagnosed as having diabetes;

2. The patient’s physician states that the patient is capable of being trained to use the

particular device prescribed in an appropriate manner. In some cases, the patient may not

be able to perform this function, but a responsible individual can be trained to use the

equipment and monitor the patient to assure that the intended effect is achieved. This is

permissible if the record is properly documented by the patient’s physician; and

3. The device is designed for home rather than clinical use.

There is also a blood glucose monitoring system designed especially for use by those

with visual impairments. The monitors used in such systems are identical in terms of

reliability and sensitivity to the standard blood glucose monitors described above. They

differ by having such features as voice synthesizers, automatic timers, and specially

designed arrangements of supplies and materials to enable the visually impaired to use

the equipment without assistance.

These special blood glucose monitoring systems are covered under Medicare if the

following conditions are met:

• The patient and device meet the three conditions listed above for coverage of

standard home blood glucose monitors; and

• The patient’s physician certifies that he or she has a visual impairment severe

enough to require use of this special monitoring system.

The additional features and equipment of these special systems justify a higher

reimbursement amount than allowed for standard blood glucose monitors. Separately

identify claims for such devices and establish a separate reimbursement amount for them.