DME and pharmacy providers shall purchase their Roche blood glucose testing supplies from one of the authorized distributors listed at. EOB 00023: SERVICE REQUIRES PRIOR APPROVALĮffective 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.THE NDC SUBMITTED IS NOT FOR A PRODUCT FROM THE PREFERRED DIABETIC SUPPLY VENDOR. If either a HCPCs code/NDC match or PA is not found then the claim line will deny and post the following EOB: Use coupon code: LISTERINENOV21 at checkout for a FREE Listerine Classic Mouthwash Cool Mint 95ml when you spend a minimum of 10 on products in the Health. 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. 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. This updated reimbursement methodology will be implemented effective for claims on or after Apand will require the claims to include the National Drug Code (NDC) along with the HCPCs code.īeginning 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. 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).
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