For those afflicted with diabetes, managing all the different devices and the disease may feel like a daunting task. Even more intimidating may be learning what devices are covered and how much is covered. There are many different ways to treat and monitor diabetes. In this article we are going to focus on a specific device and the coverage determinations.
What is a Lancet?
A Lancet is a type of device that that utilizes a pricking method to extract a drop of blood to be drawn. There are different types of lancets. One type is called a spring powered lancet which uses a spring loaded device.
How is it billed?
Spring powered lancets are billed using HCPCS (Healthcare Common Procedure Coding System) code A4528.
What to look for?
Check your plan policies as it relates to coverage determinations. For example, CMS states that more than one spring powered device per 6 months is not reasonable and necessary. [1]
· Review billing for more than one spring powered lancet in a 6 month time period.
· Review across multiple providers billing under different IDs.
If you are using the Healthcare Fraud Shield (HCFS) platform, HCFS has you covered. Our 1600+ library of alerts that is used in combination with our artificial intelligence includes the following alert:
[2620-01] – INAPPROPRIATE NUMBER OF UNITS, SPRING-POWERED DEVICES FOR LANCETS: This Alert identifies members receiving more than 1 spring-powered device in 6 months’ time, as typically it’s considered not reasonable and necessary.
REFERENCES:
[1] https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33822&ver=41&
If you have questions or comments you may email us at [email protected].