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Re: [IP] C- Peptide Test Why & What



> Next Feb. I will go on Medicare. They require a C-Peptide test,
> right? To pay for pump supplies!?!? Can someone please tell me why
> they require this test and exactly what it shows about you. I know
> we talked about it a long time ago and I forget what was said. I go
> to the doctor's tomorrow and will probably have to get the test done
> then.

The regs read:

5. 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.

--------------------------------------
It is not clear for persons qualifying under part (B) if the 
C-peptide level test is required. There are credible reports that if 
you are currently on a pump, your benefits will be covered. In any 
event, C-peptide tests are fairly unreliable in terms of exact 
numeric results. The results are highly dependent on the individual 
lab and may differer greatly from test to test. -- best advice is 
that if the results are not suitable, try a different lab or even the 
same lab at some other time.

Michael
email @ redacted
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