[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

[IP] Medicare Coverage



John + Jim  I was able to get the first pump Disetronic gave to a Medicare 
covered person. I did not haxe a c-pep test. As I have had D as a 2 year old 
and never took the test I can only assume my DR wrote a letter or sent letter 
on me being type 1. Under Medicare they give only a 1 month supply of 
supplies. ( 10 sets, two batteries, and so on) If you live in a distant area 
you can get more than 1 month at a time. If you are in snow bound Maine in 
the winter 100 miles from a supplier that would do it. I have tried to get my 
BC/BS to get a three month order, but I have not had much luck. GOOD LUCK!! 
Roger C dx 47 pm 5/00
Continuous subcutaneous insulin infusion pumps (CSII) (Effective for Services 
Performed On or After 4/1/2000).-- 
An external infusion pump and related drugs/ supplies will be covered as 
medically necessary in the home setting in the following situation: Treatment 
of Type I diabetes 

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 
3 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 4 times per day 
during the 2 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(HbAlc) > 7.0% 
(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 I diabetes has been on a pump prior to enrollment 
in Medicare and has documented frequency of glucose self-testing an average 
of at least 4 times per day during the month prior to Medicare enrollment.

 
Type I diabetes needs to be documented by a C-peptide level < 0.5 

Continued coverage of the insulin pump would require that the patient has 
been seen and evaluated by the treating physician at least every 3 months. 

----------------------------------------------------------
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml