January 26, 2017
Beginning in the first quarter of 2017, Premera's Medicare Advantage plans will cover only a preferred list of manufacturers of glucose monitors and supplies. (This information was previously announced in the December 2016 Provider News.) Starting April 1, 2017, the terms of the policy will be enforced.
To assist providers in this transition to the preferred manufacturers, a new Medicare Advantage (MA) Payment Policy has been posted to the secure external Medicare Advantage Provider website. View the policy and select the button for medical tools and resources.
The new MA policy, Billing Guidelines for Blood Glucose Monitors and Supplies (MA001), indicates that a National Drug Code (NDC) must now be submitted for the preferred blood glucose monitors and supplies on any claim submission via an electronic format (837P) or paper copy (CMS-1500). The policy details the instructions on how to submit an NDC on both the electronic and paper claim forms. Within the policy, there is a list of preferred manufacturers and HCPCS codes to use when submitting a claim for glucose monitors and associated supplies.
We encourage you to communicate with your patients about the change in payment and the list of preferred manufacturers and products.