Endocrine Insider
April 1, 2010

(See Full Issue)

A new policy implemented by the four durable medical equipment (DME) Medicare Administrative Contractors (MACs) restricts the acceptable means by which to identify beta-cell autoantibodies to qualify Medicare patients for coverage of insulin pumps.  Though a number of tests are currently in use to identify the autoantibodies, the MACs have determined that only the Islet Cell Cytoplasmic Autoantibody test can be used to qualify patients for insulin pumps. 

According to a 2004 National Coverage Determination (NCD), Medicare patients can qualify for insulin pumps either by demonstrating a positive result on a beta cell autoantibody lab test or through a c-peptide test.  The NCD never specified which lab tests were appropriate to meet the beta-cell autoantibody criterion nor did any of the Local Coverage Determinations (LCD) created by the DME MACs to implement the 2004 NCD.  While c-peptide remains a second option for a qualifying test, the implementation of the beta-cell autoantibody restriction may change the approach physicians take in diagnosing and treating patients with diabetes. 

Further information on the policy change may be found through the links below.

DME MAC Jurisdiction A (NHIC Corporation)
http://www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin
_current/110509_beta-cell.pdf
 
DME MAC Jurisdiction B (National Government Services)
http://www.ngsmedicare.com/Content.aspx?CatID=3&DOCID=20906
 
DME MAC Jurisdiction C (CIGNA Government Services)
http://www.cignagovernmentservices.com/jc/pubs/news/2009/1109/
cope10984.html
 
DME MAC Jurisdiction D (Noridian Administrative Services)
https://www.noridianmedicare.com/dme/news/docs/2009/11_nov
/insulin_pump_qualification_beta_cell_antibody_coding_reminder.html

The Endocrine Society will determine whether this policy change is consistent with the 2004 NCD and if it was implemented through the normal regulatory process.  Please look for additional information in future editions of Endocrine Insider.