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[IP] Re: C-Peptide and Medicare



> From: april smith <email @ redacted>
>
> Has anyone had to have a c-peptide test so that medicare will cover their
pump supplies? > I have been on a minimed 507 since 1997 and had to have one
recently to send to
> medicare. I do not have the results yet but know that the normal range is
above 0.5 and
> was curious as to what everyone else's results turned out to be. I have
had type 1 for 29 > years but for some odd reason this test has made me
anxious. I know it sounds crazy but > what if after being in dka many times
I find out my body has been making some insulin?
> April

April-
If , as a type 1 diabetic, you  have been using a pump, and testing bG's
four times a day, prior to enrolling in Medicare then, as I see it, you
qualify for pump and related supplies coverage regardless of c-peptide test
results.  Following, is a copy of HCFA's statement (see section B), as
reported on ADA's web site, regarding coverage and the necessary
qualifications.  "Severe glycemic excursions", as indicated by your frequent
DKA episodes, would also qualify you.

~*~*~*~*~*~*~*~*~*~*
The amended HCFA coverage manual 60-14 states that "In order to be covered,
patients must meet criterion A or B:

A. The patient has completed a comprehensive diabetes education program, and
has been on a program of multiple daily injections of insulin (i.e., at
least three injections per day), with frequent self-adjustments of insulin
dose for at least 6 months prior to initiation of the insulin pump, and has
documented frequency of glucose self-testing an average of at least four
times per day during the two months prior to initiation of the insulin pump,
and meets one or more of the following criteria while on the multiple daily
injection regimen:
(1) Glycosylated hemoglobin level (HbA1c) > 7.0 percent
(2) History of recurring hypoglycemia
(3) Wide fluctuations in blood glucose before mealtime
(4) Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl
(5) History of severe glycemic excursions

B. The patient with type 1 diabetes has been on a pump prior to enrollment
in Medicare and has documented frequency of glucose self-testing an average
of at least four times per day during the month prior to Medicare
enrollment."

John Kinsley
email @ redacted
Type 1 since 1956
MM 507 since 6/9/98

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