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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
The rules state that to be eligible for coverage of home blood glucose monitors and related accessories and 
supplies, the beneficiary must meet both of the following basic criteria (1)-(2): 
1. The beneficiary has diabetes (Refer to the ICD-10 code list in the LCD-related Policy Article for applicable 
diagnoses); and, 
2. The beneficiarys treating practitioner has concluded that the beneficiary (or the beneficiarys caregiver) has 
sufficient training using the particular device prescribed as evidenced by providing a prescription for the 
appropriate supplies and frequency of blood glucose testing. 
 
The rules also say that the quantity of test strips (code A4253) and lancets (code A4259) that are covered 
depends on the usual medical needs of the beneficiary and whether or not the beneficiary is being treated with 
insulin, regardless of their diagnostic classification as having Type 1 or Type 2 diabetes mellitus. Coverage of 
testing supplies is based on the following guidelines: 
 
Usual Utilization: 
 
For a beneficiary who is not currently being treated with insulin administrations, up to 100 test strips and up to 
100 lancets every 3 months are covered if the basic coverage criteria (1)-(2) (above) are met. 
For a beneficiary who is currently being treated with insulin administrations, up to 300 test strips and up to 300 
lancets every 3 months are covered if basic coverage criteria (1)-(2) (above) are met. 
 
High Utilization: 
For a beneficiary who is not currently being treated with insulin administrations, more than 100 test strips and 
more than 100 lancets every 3 months are covered if criteria (a)(c) below are met. 
For a beneficiary who is currently being treated with insulin administrations, more than 300 test strips and 
more than 300 lancets every 3 months are covered if criteria (a)(c) below are met. a. Basic coverage criteria (1)-(2) listed above for all home glucose monitors and related accessories and 
supplies are met; and, 
b. Within the six (6) months prior to ordering quantities of strips and lancets that exceed the utilization 
guidelines, the treating practitioner has had an in-person visit with the beneficiary to evaluate their 
diabetes control and their need for the specific quantity of supplies that exceeds the usual utilization 
amounts described above; and, 
c. Every six (6) months, for continued dispensing of quantities of testing supplies that exceed the usual 
utilization amounts, the treating practitioner must verify adherence to the high utilization testing 
regimen. 
If neither basic coverage criterion (1) or (2) is met, all testing supplies will be denied as not reasonable and 
necessary. If quantities of test strips or lancets that exceed the utilization guidelines are provided and criteria 
(a)(c) are not met, the amount in excess will be denied as not reasonable and necessary. 
You can find this information in the Local Coverage Determination (LCD): Glucose Monitors (L33822). 
 
The rules say that Medicare Advantage (MA) plans may specify brands and manufacturers as preferred and 
charge lower cost-sharing for the preferred brands or may limit the durable medical equipment (DME) to only 
those preferred brands and manufacturers, as long as they ensure that enrollees have access to all medically 
necessary (including non-preferred) DME products or brands. You can find this information in the Centers for 
Medicare and Medicaid Services Internet Only Manual, Publication 100-16, Medicare Managed Care Manual 
Chapter 4, 10.12.2. 
 
The rules say that a health plan must disclose to its enrollees, in clear accurate terms, the benefits offered under 
a plan, including applicable conditions and limitations, premiums and cost-sharing, and any other conditions 
associated with receipt or use of benefits. You can find this rule at 42 CFR Section 422.111(a) and (b). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules. 
 
The Plan contract also says that these are the only covered brands of blood glucose monitors and test strips: 
ACCU-CHEK manufactured by Roche, or Trividia products sometimes packaged under your pharmacys 
name. You can find this information on page 51 of the Plan's 2023 Evidence of Coverage (EOC).