New Pricing Methodology for DME Blood Glucose Supplies

On April 29, 2018, Durable Medical Equipment (DME) Blood Glucose testing equipment and supply codes A4253, A4256, A4258 and A4259 will be priced according to current State Maximum Allowable Cost (SMAC).  

This updated reimbursement methodology will be implemented effective for claims on or after April 1, 2018 and will require the claims to include the National Drug Code (NDC) along with the HCPCs code.  

Beginning April 1 through April 29, claims submitted for DME Blood Glucose testing equipment and supply codes referenced above will "pend" in the NCTracks system and they will be automatically released for processing after implementation of the system changes. Non-preferred brand diabetic testing supplies will continue to require prior authorization (PA) and will be reimbursed at the non-preferred rates indicated in the table below. 

Providers should consider submitting DME charges unrelated to these DME codes on separate claims to prevent a delay in payment. Secondary claims will continue to price using the lesser of logic and all existing QMB rules. Future communications will be provided regarding any reprocessing of claims related to this change.

If either a HCPCs code/NDC match or PA is not found then the claim line will deny and post the following EOB:

  • EOB 01841: CLAIM DENIED. THE NDC SUBMITTED IS NOT FOR A PRODUCT FROM THE PREFERRED DIABETIC SUPPLY VENDOR.
  • EOB 00023: SERVICE REQUIRES PRIOR APPROVAL

Effective April 1, 2018, the following chart outlines the Roche diabetic testing supplies with their corresponding preferred NDC/HCPC code, and current rates for non-preferred and preferred diabetic supplies. DME and pharmacy providers shall purchase their Roche blood glucose testing supplies from one of the authorized distributors listed at: https://rxvp.accu-chek.com/welcome/adr_list.

 

Product

NDC Number

CPT Code

NC Medicaid SMAC Rate

ACCU-CHEK® AVIVA PLUS 50 ct Test Strips

65702-0407-10

A4253

$79.63/box of 50

ACCU-CHEK® SMARTVIEW 50 ct Test Strips

65702-0492-10

A4253

$79.63/box of 50

ACCU-CHEK® COMPACT

51 ct Test Strips

50924-0988-50

A4253

$81.67/box of 51

ACCU-CHEK® GUIDE 50 ct Test Strips

65702-0711-10

A4253

$21.56/box of 50

Non-preferred Brand 50 ct Test Strips

n/a

A4253

$29.46/box of 50

ACCU-CHEK® SOFTCLIX Lancing Device Kit (Black)

65702-0400-10

A4258

$22.63 each

ACCU-CHEK® FASTCLIX Lancing Device Kit

65702-0481-10

A4258

$17.55 each

Non-preferred Brand Spring-powered Device for Lancet, Each

n/a

A4258

$17.55 each

ACCU-CHEK® MULTICLIX 102 ct Lancets

50924-0450-01

A4259

$15.68/box of 102

ACCU-CHEK® SOFTCLIX

100 ct Lancets

50924-0971-10

A4259

$13.93/box of 100

ACCU-CHEK® FASTCLIX

102 ct Lancets

65702-0288-10

A4259

$13.68/box of 102

Non-preferred Brand Lancets, 100 per Box

n/a

A4259

$10.69/box of 100

ACCU-CHEK® AVIVA Glucose Control Solution (2 levels)

65702-0107-10

A4256

$11.13/bottle

ACCU-CHEK® COMPACT PLUS CLEAR Glucose Control Solution (2 levels)

65702-0468-10

A4256

$11.13/bottle

ACCU-CHEK® GUIDE Glucose Control Solution (2 levels)

65702-0713-10

A4256

$11.13/bottle

ACCU-CHEK® SMARTVIEW Glucose Control Solution (2 levels)

65702-0488-10

A4256

$11.13/bottle

Non-preferred Brand Calibrator Solution/Chips, Each

n/a

A4256

$11.13/bottle