NCD190.20

 

BLOOD GLUCOSE TESTING

 

Effective Date of this Version

3/11/2005

 

Benefit Category

• Diagnostic Laboratory Tests.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• This policy is intended to apply to blood samples used to determine glucose levels.

• Blood glucose determination may be done using whole blood, serum or plasma.

• It may be sampled by

o Capillary puncture, as in the fingerstick method.

o By vein puncture or arterial sampling.

• The method for assay may be

o By color comparison of an indicator stick.

o By meter assay of whole blood or a filtrate of whole blood, using a device approved for home monitoring.

o By using a laboratory assay system using serum or plasma.

• The convenience of the meter or stick color method allows a patient to have access to blood glucose values in less than a minute or so and has become a standard of care for control of blood glucose, even in the inpatient setting.

 

Indications and Limitations of Coverage

Indications

• Blood glucose values are often necessary for the management of patients with diabetes mellitus, where hyperglycemia and hypoglycemia are often present.

o They are also critical in the determination of control of blood glucose levels in

 The patient with impaired fasting glucose (FPG 110-125 mg/dL).

 The patient with insulin resistance syndrome and/or carbohydrate intolerance (excessive rise in glucose following ingestion of glucose or glucose sources of food).

 The patient with a hypoglycemia disorder such as nesidioblastosis or insulinoma.

 Patients with a catabolic or malnutrition state.

o In addition to those conditions already listed, glucose testing may be medically necessary in patients with

 Tuberculosis.

 Unexplained chronic or recurrent infections.

 Alcoholism.

 Coronary artery disease (especially in women).

 Unexplained skin conditions (including pruritis, local skin infections, ulceration and gangrene without an established cause).

• Many medical conditions may be a consequence of a sustained elevated or depressed glucose level.

o These include

 Comas.

 Seizures or epilepsy.

 Confusion.

 Abnormal hunger.

 Abnormal weight loss or gain.

 Loss of sensation.

o Evaluation of glucose may also be indicated in patients on medications known to affect carbohydrate metabolism.

• Effective January 1, 2005, the Medicare law expanded coverage to diabetic screening services.

o Some forms of blood glucose testing covered under this national coverage determination may be covered for screening purposes subject to specified frequencies.

o See 42 CFR 410.18 and section 90, chapter 18, of the Claims Processing Manual, for a full description of this screening benefit.

 

Limitations

• Frequent home blood glucose testing by diabetic patients should be encouraged.

o In stable, non-hospitalized patients who are unable or unwilling to do home monitoring, it may be reasonable and necessary to measure quantitative blood glucose up to four times annually.

• Depending upon the age of the patient, type of diabetes, degree of control, complications of diabetes, and other co-morbid conditions, more frequent testing than four times annually may be reasonable and necessary.

• In some patients presenting with nonspecific signs, symptoms, or diseases not normally associated with disturbances in glucose metabolism, a single blood glucose test may be medically necessary.

o Repeat testing may not be indicated unless abnormal results are found or unless there is a change in clinical condition.

o If repeat testing is performed, a specific diagnosis code (e.g., diabetes) should be reported to support medical necessity.

o However, repeat testing may be indicated where results are normal in patients with conditions where there is a confirmed continuing risk of glucose metabolism abnormality (e.g., monitoring glucocorticoid therapy).

• Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).

 

Cross Reference

• Medicare Claims Processing Manual, Chapter 16, Section 120, Clinical Laboratory Services Based on Negotiated Rulemaking.

 

Coverage Transmittal Link

• http://www.cms.gov/transmittals/downloads/r28ncd.pdf

 

Other

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Coding Analyses for Labs (CALs)

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with CALs, from the Coding Analyses for Labs database.

• Original consideration for Blood Glucose Testing (Revision of ICD-9-CM Codes for Osteomyelitis) (CAG-00183N)

• Original consideration for Lipid and Blood Glucose Testing (Modification of Code List to Implement Screening Benefit Added by Medicare Modernization Act (MMA) (CAG-00266N)

 

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