LCD for Blood Glucose Testing (L1316)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L1316 

 

LCD Title 

Blood Glucose Testing 

 

Contractor's Determination Number 

1316 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

Title XVIII of the Social Security Act, Section 1862 (a)(1)(A). This section excludes coverage of items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1862 (a)(7). This section prohibits Medicare payment for any expenses on items and services incurred for routine physical examinations.

Title XVIII of the Social Security Act, Section 1833 (e). This section prohibits Medicare payment for any claim that lacks the necessary information to process the claim.

CMS Pub 100-4, 16-§10.2, 16-§30.4, 20, 20.1, 30.1, 30.2, 30.3, 40.1, 40.4, 40.7, 50.1, 60, 60.1, 60.1.1, 60.2, 80.4, 100, 110, 23-§40.

42CFR410.32. Diagnostic tests may only be ordered by a treating physician (or other treating practitioner acting within the scope of their license and Medicare requirements). 

 

Primary Geographic Jurisdiction 

New Jersey
Tennessee
 

 

Secondary Geographic Jurisdiction 

Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
North Carolina
North Dakota
Nebraska
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 02/20/1997  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 07/23/2005  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

This policy represents RGBA implementation of the National Coverage Decision (NCD) on Blood Glucose Testing and interpretation of the Program Memorandum on Blood Glucose Testing (82962)for Skilled Nursing Facilities.


Blood glucose testing is performed to:

 

  • diagnose hypoglycemia
  • diagnose hyperglycemia
  • aid in the management of diabetes mellitus




Blood glucose testing is not eligible for coverage when performed for:

 

  • screening purposes in asymptomatic individuals
  • individuals without signs or symptoms of hypoglycemia or hyperglycemia without diagnoses related to diabetes mellitus
  • a diagnostic condition unrelated to hypo- or hyperglycemia or diabetes mellitus


The routine or standing order use of a home glucose monitoring device (82962) will only be considered medically necessary as a laboratory procedure when the physician is PROMPTLY informed of the result PRIOR to the next testing episode. Blood glucose monitoring by 82962 without this reporting is part of the patients' self-care. If the patient is in a skilled nursing facility, routine glucose monitoring (including any tests, which are not promptly reported) is a part of routine personal care and is not a separately reportable or billable procedure. (PM AB-00-108 of December 2000).


Reasons for Denial:

Tests for screening purposes that are performed in the absence of signs, symptoms, complaints, or personal history of disease or injury.

Exams required by insurance companies, business establishments, government agencies, or other third parties.

It is expected that glucose testing performed for a sign or symptom [e.g., collapse or giddiness]for which etiology is not clear, is being done to rule out hypoglycemia, etc. 

 

Coverage Topic 

Lab Services
 

 

Coding Information

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

12x

Hospital-inpatient or home health visits (Part B only)

13x

Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00)

14x

Non-Patient Laboratory Specimens

21x

SNF-inpatient, Part A

22x

SNF-inpatient or home health visits (Part B only)

23x

SNF-outpatient (HHA-A also)

71x

Clinic-rural health

 

 

Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

030X

Laboratory-general classification

031X

Laboratory pathological-general classification

 

 

CPT/HCPCS Codes 

Laboratory

82947

GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)

82948

GLUCOSE; BLOOD, REAGENT STRIP

82962

GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE

 

 

ICD-9 Codes that Support Medical Necessity 

Refer to the Clinical Diagnostic Laboratory Services -National Coverage Decisions (NCDs) for the ICD-9 code requirements.

XX000

Not Applicable

 

 

Diagnoses that Support Medical Necessity 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

 

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

Documentation supporting medical necessity must be submitted if additional documentation is requested. Submit:

 

  • M.D. orders/progress notes
  • Diagnosis/Reason for test
  • Test results
  • Itemization of charges

 

 

Appendices 


 

 

Utilization Guidelines 

 

 

Sources of Information and Basis for Decision 

1999 CPT Book, American Medical Association

Diagnostic Tests Handbook, Springhouse corporation, 1987.

Carrier Policies 

 

Advisory Committee Meeting Notes 

This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from appropriate specialties as well as provider (facility) representatives. 

 

Start Date of Comment Period 

11/27/1996 

 

End Date of Comment Period 

 

 

Start Date of Notice Period 

01/20/1997 

 

Revision History Number 

1316a 

 

Revision History Explanation 

01/14/2003 Deleted non-explanatory information already contained in the NCD on Blood Glucose Testing

07/08/2002 Clarification of "Treatment under AI" and formatted.

04/03/2002 Deleted obsolete codes from 01/05/01 revision

02/08/2002 Revision to ICD-9 Code [2002 ICD-9-CM]

01/18/2002 Updated codes (Negotiated Rulemaking: Coverage and Administrative Policies for Clinical Diagnostic Laboratory Services; Final Rule: Nov 2001)

01/05/2001 Codes updated with ICD-9 Code Book 2001 and CPT Code Book 2001

Clarification of self-care monitoring vs medically necessary laboratory testing

This LCD was converted from an LMRP on 7/22/2005

7/2/2006 - The description for Bill code 14 was changed

10/02/2007 - Frequently Asked Questions restored to Appendices.

2/18/2008 - The description for Bill code 21 was changed

3/20/2008 - Frequently Asked Questions removed from Appendices 

 

Reason for Change 

Other
 

Last Reviewed On Date 

03/20/2008 

 

Related Documents 

Article(s)
A37759 - Blood Glucose Testing

 

LCD Attachments 

FAQ (5,539 bytes)

 

Other Versions 

Updated on 02/18/2008 with effective dates 07/23/2005 - N/A

Updated on 10/02/2007 with effective dates 07/23/2005 - N/A

Updated on 09/01/2006 with effective dates 07/23/2005 - N/A

Updated on 07/02/2006 with effective dates 07/23/2005 - N/A

Updated on 07/22/2005 with effective dates 07/23/2005 - N/A

Updated on 07/22/2005 with effective dates 01/14/2003 - 07/22/2005

Updated on 02/15/2003 with effective dates 01/14/2003 - N/A

Updated on 01/13/2003 with effective dates 01/14/2003 - N/A

Updated on 10/04/2002 with effective dates 07/08/2002 - 01/13/2003