How can I order a blood‑glucose meter and test strips for a Medicare‑eligible patient with diabetes (e.g., on insulin therapy)?

Ordering Glucose Monitors and Test Strips for Medicare Patients

Medicare Part B covers blood glucose meters and test strips as durable medical equipment (DME) when prescribed by a physician for patients with diabetes, particularly those on insulin therapy, and must be obtained through Medicare-approved DME suppliers using proper documentation and billing procedures. 1

Medicare Coverage Requirements

Patient Eligibility Criteria

• Medicare Part B covers glucose monitoring supplies for beneficiaries with diabetes who meet specific clinical criteria. 1
• Patients on insulin therapy have the strongest indication for coverage, as blood glucose monitoring is integral to safe insulin management and hypoglycemia prevention. 2
• Coverage extends to patients on multiple daily injections or insulin pump therapy who require testing 6-10 times daily depending on individual needs. 2

Required Documentation

• A physician's written order (prescription) is mandatory before DME suppliers can dispense glucose meters and test strips. 1
• The prescription must document the diabetes diagnosis and specify the medical necessity for glucose monitoring. 1
• For insulin-treated patients, documentation should note the insulin regimen (basal, bolus, or both) to justify testing frequency. 2

Ordering Process

Step 1: Write the Prescription

• Prescribe an FDA-approved glucose meter with proven accuracy, specifying the quantity of test strips based on the patient's insulin regimen. 2
• For patients on intensive insulin therapy (multiple daily injections or pump), prescribe sufficient strips for testing before meals and snacks, at bedtime, before exercise, when hypoglycemia is suspected, and before critical tasks like driving—typically 6-10 tests daily. 2
• Include lancets in the prescription, as they are covered alongside test strips. 1
• Specify that strips must be unexpired and purchased from a pharmacy or licensed distributor. 2

Step 2: Direct Patient to Medicare-Approved DME Supplier

• Patients must obtain supplies through Medicare-enrolled DME suppliers who have been approved by Medicare administrative contractors. 1
• Verify the supplier's Medicare enrollment status, as only approved suppliers can bill Medicare Part B for diabetes testing supplies. 1
• Many chain pharmacies are Medicare-approved DME suppliers and can process these orders. 1

Step 3: Supplier Responsibilities

• The DME supplier will verify Medicare eligibility and obtain the physician's written order before dispensing supplies. 1
• Suppliers must maintain documentation of medical necessity and comply with national and local coverage requirements. 1
• The supplier bills Medicare Part B directly for covered supplies. 1

Testing Frequency Guidelines by Treatment Regimen

Intensive Insulin Therapy (Multiple Daily Injections or Pump)

• Prescribe strips for 6-10 tests daily: before meals and snacks, at bedtime, occasionally postprandially, before exercise, when hypoglycemia is suspected, after treating hypoglycemia until normoglycemic, and before critical tasks. 2

Basal Insulin Only or Non-Insulin Therapy

• Testing frequency should be lower and individualized, as routine glucose monitoring in non-insulin-treated patients has limited clinical benefit unless used to adjust therapy. 2
• Consider prescribing strips for fasting glucose checks and periodic postprandial testing when modifying meal plans, physical activity, or medications. 2

Critical Pitfalls to Avoid

Accuracy and Safety Issues

• Never prescribe non-FDA-approved meters, as accuracy varies significantly between devices and only FDA-approved meters should be used. 2
• Warn patients against purchasing preowned or secondhand test strips, as these may give incorrect results and compromise safety. 2
• Ensure patients understand that only unopened, unexpired strips from licensed distributors should be used. 2

Billing and Compliance Concerns

• Be aware that diabetes testing supplies are subject to extensive Medicare audits due to concerns about improper billing. 1
• Ensure medical necessity is clearly documented to avoid prepayment review or postpayment audits. 1
• Do not order excessive quantities that exceed clinical need, as this triggers Medicare contractor scrutiny. 1

Clinical Considerations

• Patients using continuous glucose monitoring (CGM) must still have access to blood glucose meters at all times for calibration (if required by device) and backup testing. 2
• Provide education on proper meter use, as performing blood glucose monitoring alone does not lower glucose levels—the information must be integrated into self-management plans. 2
• Reevaluate the ongoing need and frequency of testing at each routine visit to avoid overuse, particularly if monitoring is not being used effectively for self-management. 2

Alternative: Pharmacy Benefit Coverage

• Some state Medicaid programs and insurers have transitioned CGM coverage from DME to pharmacy benefit, which improves access and reduces administrative burden. 3
• For Medicare patients, traditional glucose meters and strips remain under Part B DME coverage, but this landscape may evolve. 1, 3