Diabetes Billing Codes
and Guidelines
Diabetes Supplies Billing Guidelines
The Medicare Diabetes Guidelines require you to submit a Standard Written Order for your patient before they can receive diabetes supplies. The prescription must include the following to comply with diabetes guidelines for billing insurance:
- Patient DOB
- Diagnosis
- Duration of need
- Treatment Type
- Brand (if applicable)
- Extra Supplies (if applicable)
- Physician Name
- NPI
- Physician Signature
A new SWO is needed any time you need to add an item to your patient's order or change their treatment. We advise you to document your patient's continued needs yearly.
Diabetes Medical Record Requirements
Your patient's insurance may also require information from their medical record related to billing for diabetes supplies you request on their behalf. Medical records must corroborate the SWO and include the following:
- Must be a diabetic, and;
- Administering Insulin or;
- Type 2 with documented Hypoglycemia-Must be
documented in Medical Records - Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmoI/L)) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or,
- A history of one level 3 hypoglycemic event (glucose < 54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia, and
- Must be seen by the treating physician every 6 months-face to face
Commercial Plans
Most commercial plans still require multiple injections and multiple testing times. As you know, commercial insurance guidelines for diabetes can vary from plan to plan. Strive Diabetes can answer all your questions about your insurance.
Only a handful of commercial payers accept hypoglycemia as documented above.
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