Blood Glucose Testing in Skilled Nursing Facilities (SNF) This article is a reissue of an article originally published in the Medicare News Update (MNU) 2004-2. Empire Medicare Services has been made aware through Comprehensive Error Rate Testing (CERT) findings and data analysis of provider billing practices, that SNFs continue to bill for Blood Glucose Monitoring. Please note that this service is covered only in very specific circumstances, never for routine monitoring. Pub. 100-04, Chapter 7 - 90.1 - Glucose Monitoring “Medicare Part B may pay for a glucose monitoring device and related disposable supplies under its durable medical equipment benefit if the equipment is used in the home or in an institution that is used as a home. A hospital or SNF is not considered a home under this benefit (§1861(h) of the Act, 42 CFR 410.38). Routine glucose monitoring of diabetics is never covered in a SNF, whether the beneficiary is in a covered Part A stay or not. Glucose monitoring may only be covered when it meets all the conditions of a covered laboratory service, including use by the physician modifying the patient’s treatment.” In response to a new wave of inappropriate billing and requests from Empire’s SNF Association Partners, we are republishing the policy clarification for blood glucose testing in a skilled nursing facility (SNF) that was originally published in Medicare News Update 2000-13. As Empire Medicare Services originally reported in December 2000, MNU 2000-13, in certain circumstances, blood glucose testing may be reimbursed for a beneficiary living in a skilled nursing facility under Medicare Part B when the beneficiary is not covered by Part A. MNU 2000-13 noted that payment may be made to those providers who are registered under the Clinical Laboratory Improvement Amendments (CLIA), as well as those registered only with a certificate of waiver. The device used to perform the finger-stick blood glucose test has been added to the list of approved devices under CLIA. Local Coverage Determinations on these tests remain in effect in the absence of a national policy. The conditions under which intermediaries may reimburse for blood glucose laboratory tests when provided by finger-stick methodology are:
Repeated performance of finger-stick blood glucose tests to maintain standing orders for insulin injection does not meet the criteria listed above. The SNF may not bill for repeated laboratory charges unless there is physician involvement based on the results of the individual test. Whenever this form of laboratory test results in physician contact, for modification of patient care, the test can be billed to the intermediary. This requires documentation of the physician intervention and change in orders. In this circumstance, submit a claim to the intermediary on a CMS-1450 using bill type 22X for Part B beneficiaries in a certified bed, and bill type 23X for beneficiaries in a noncertified bed. Bill types 22X and 23X will be reimbursed at the lower of billed charges or the laboratory fee schedule rate. Deductible and coinsurance do not apply. The effective date for this policy clarification is for services beginning November 1, 2000. |
