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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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