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[IP] Re: C-Peptide and Medicare

> From: Jim Holman <email @ redacted>
> Subject: Re: [IP] Re: C-Peptide and Medicare
> John I couldn't locate the coverage criteria on the ADA page. The Coverage
> Issues Manual Durable Medical Equipment of HCFA states what your report of
> the ADA site has but does have the tag line below the B criteria of:
> "Type I diabetes needs to be documented by a C-peptide level < 0.5"
> Does the ADA site indicate the date of issue and or the revision date of
> their information?

Jim, the ADA did not include the statement referring to a qualifying
C-peptide test for type 1 diabetes.  The date of the HCFA statement on the
ADA web page is September 24,1999.  However, a physician's diagnosis and
statement that a patient has type 1 diabetes should be sufficient and
documentation of frequent episodes of DKA also makes the need for a
C-peptide test redundant and unnecessary.  Thank you for pointing out the
referrence to C-peptide in the original document but, in my opinion, it only
serves as a needless hurdle and an excessive waste of effort and expense.

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

> This can be found at http://www.hcfa.gov/pubforms/06%5Fcim/ci60.htm#_1_10
> Does the ADA site indicate the date of issue and or the revision date of
> their information?
> Jim
> At 12:20 AM 6/27/00 -0400, you wrote:
> >"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
> >patients must meet criterion A or B:
> >
> >A. The patient has completed a comprehensive diabetes education program,
> >has been on a program of multiple daily injections of insulin (i.e., at
> >least three injections per day), with frequent self-adjustments of
> >dose for at least 6 months prior to initiation of the insulin pump, and
> >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
> >and meets one or more of the following criteria while on the multiple
> >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
> >(5) History of severe glycemic excursions
> >
> >B. The patient with type 1 diabetes has been on a pump prior to
> >in Medicare and has documented frequency of glucose self-testing an
> >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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