UNDERSTAND MORE. MANAGE BETTER.
Patients may receive Medicare-covered Diabetes Management services when satisfying the necessary general patient qualifications and when the following specifications are met.
Insulin Injections
- Substantiating factors are documented
- A patient is unable to safely self-inject
- No caregiver is willing or able to provide injections at the necessary frequency
Diabetic Supplies
- A blood glucose monitor and/or non-routine supplies may be covered if a skilled nurse is administering insulin to a patient
- Finger-stick supplies may be covered if a patient is insulin-treated and documentation supports medical necessity or indicates an unstable diabetic condition
Pre-filling Syringes
- Pre-filled syringes are covered if a patient first qualifies for some other skilled nursing service
Diabetic Training
- Documentation must clearly substantiate need for initial training
- Supporting documentation is required if a patient requires continued coverage after initial certification
Home Health Aide
- Home health aide services are covered if a patient first qualifies for some other skilled service
- The frequency and duration of home health aide services are dependent on a patient's functional status
Medical Social Work
- Medical social work services are covered if a patient first qualifies for some other skilled service
Substantiating Factors
The following conditions substantiate the need for Medicare-covered insulin injections provided by a home health skilled nurse:
- Diagnosis with recent onset
- Recent initiation of insulin injections
- Abnormal and/or fluctuating lab values
- Accompanying conditions of the skin
- Required adjusted dietary management
- Manifestation of symptoms indicative of complications: polyuria, weight loss, lethargy, visual disturbances, non-healing wounds, pruritis and UTI
- Require medication adjustments
- Significant glycosuria
- Recent hospitalization
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