NCTracks
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 |