QuestionMay 31, 2025

A patient drops off a written prescription for "glucose test strips for #100, test QD, for non-insulin dependent diabetes (E11.9)'' with PRN refills for one year.Based on this information, can you bill this prescription to Medicare Part B? Yes No

A patient drops off a written prescription for "glucose test strips for #100, test QD, for non-insulin dependent diabetes (E11.9)'' with PRN refills for one year.Based on this information, can you bill this prescription to Medicare Part B? Yes No
A patient drops off a written prescription for "glucose test strips for #100, test QD, for non-insulin dependent diabetes (E11.9)'' with PRN refills for one year.Based on this information, can you bill this prescription to Medicare Part B? Yes No

Solution
4.3(198 votes)

Answer

No Explanation 1. Identify Coverage Criteria Medicare Part B covers glucose test strips for patients with diabetes, but specific criteria must be met. 2. Check Diagnosis Code The diagnosis code (E11.9) indicates non-insulin dependent diabetes, which is typically covered under Medicare Part B for glucose test strips. 3. Evaluate Prescription Details The prescription specifies "test QD" (once daily), which aligns with typical coverage guidelines for Medicare Part B. 4. Assess Refill Instructions PRN refills for one year may not align with Medicare Part B's standard refill policies, which often require specific quantities and frequencies. 5. Conclusion on Billing Eligibility While the diagnosis and daily testing are appropriate, the PRN refill instruction might not meet Medicare Part B requirements without further clarification or adjustment.

Explanation

1. Identify Coverage Criteria<br /> Medicare Part B covers glucose test strips for patients with diabetes, but specific criteria must be met.<br /><br />2. Check Diagnosis Code<br /> The diagnosis code $(E11.9)$ indicates non-insulin dependent diabetes, which is typically covered under Medicare Part B for glucose test strips.<br /><br />3. Evaluate Prescription Details<br /> The prescription specifies "test QD" (once daily), which aligns with typical coverage guidelines for Medicare Part B.<br /><br />4. Assess Refill Instructions<br /> PRN refills for one year may not align with Medicare Part B's standard refill policies, which often require specific quantities and frequencies.<br /><br />5. Conclusion on Billing Eligibility<br /> While the diagnosis and daily testing are appropriate, the PRN refill instruction might not meet Medicare Part B requirements without further clarification or adjustment.
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