Diabetes Medicare Part B Allowable Amounts and Guidelines
General Description
HCPCS
Medicare Quantity Guidelines
Guidelines
for additional quantities
One Piece Systems
Non Insulin
Dependant
Insulin
Dependant
Home Glucose Monitor
E0607
1 per 5 years
1 per 5 years
Blood Glucose Reagent Test Strips
A4253
100 per 3 months
100 per month (up to 3 month supply)
Lancets
A4259
100 per 3 months
100 per month(up to 3 month supply)
Spring Powered Lancing Device
A4258
1 per 6 months
1 per 6 months
Insulin
Alcohol Wipes
Alcohol or peroxide
Urine Test or Reagent Strips or Tablets per 100
Note: Monthly allowable amounts do not represent a benefit limit. The actual quantity needed by a particular customer may be more or less than the amount listed, depending on the individual customer's medical condition. Customers ordering over the allowable amount must have appropriate medical justification, including a one-month log of all blood glucose readings.
