TL;DR: The Centers for Medicare & Medicaid Services modified NCD 98, the national coverage determination governing blood glucose testing under Medicare, effective March 7, 2026. Here's what changes for billing teams.
This update to the CMS blood glucose testing coverage policy clarifies medical necessity criteria, testing frequency limits, and the conditions that justify repeat testing. The policy does not list specific CPT or HCPCS codes — your Medicare Administrative Contractor may publish local coverage determinations that assign codes at the regional level. If your practice bills blood glucose testing to Medicare, review this policy before billing for services rendered on or after the effective date of March 7, 2026.
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Blood Glucose Testing — NCD 98 |
| Policy Code | NCD 98 Medicare |
| Change Type | Modified |
| Effective Date | 2026-03-07 |
| Impact Level | Medium |
| Specialties Affected | Endocrinology, Internal Medicine, Primary Care, Clinical Laboratory, Home Health |
| Key Action | Audit your blood glucose testing claims for frequency compliance and medical necessity documentation before submitting claims dated March 7, 2026 or later |
CMS Blood Glucose Testing Coverage Criteria and Medical Necessity Requirements 2026
NCD 98 is the National Coverage Determination that governs Medicare coverage of blood glucose testing. The Centers for Medicare & Medicaid Services updated this policy on March 7, 2026. It applies to blood samples used to determine glucose levels — including whole blood, serum, or plasma — collected by capillary puncture (fingerstick), venipuncture, or arterial sampling.
The real issue with this coverage policy is frequency. CMS draws a clear line between stable outpatients and everyone else. For stable, non-hospitalized patients who won't or can't do home monitoring, Medicare covers quantitative blood glucose testing up to four times per year. That's it. If your billing team is submitting more than four claims annually for this patient type without clinical justification, you're exposed to claim denial.
More frequent testing clears the medical necessity bar when clinical factors support it. CMS specifically names the age of the patient, type of diabetes, degree of control, complications of diabetes, and other co-morbid conditions as factors that can justify higher frequency. Document those factors explicitly in the medical record before the claim goes out.
Covered Indications Under the 2026 CMS Blood Glucose Testing Policy
CMS covers blood glucose testing as medically necessary across a broader set of conditions than most billing teams realize. Diabetes mellitus is the obvious one — both hyperglycemia and hypoglycemia management qualify. But the policy also covers patients with impaired fasting glucose (defined as FPG 110–125 mg/dL), insulin resistance syndrome, carbohydrate intolerance, hypoglycemia disorders such as nesidioblastosis or insulinoma, and patients in catabolic or malnutrition states.
Beyond metabolic conditions, CMS lists several conditions where glucose testing may be medically necessary: tuberculosis, unexplained chronic or recurrent infections, alcoholism, coronary artery disease (especially in women), and unexplained skin conditions including pruritis, local skin infections, ulceration, and gangrene without an established cause.
CMS also covers glucose testing when symptoms could be a consequence of sustained elevated or depressed glucose. Those include comas, seizures or epilepsy, confusion, abnormal hunger, abnormal weight loss or gain, and loss of sensation. Patients on medications known to affect carbohydrate metabolism also qualify.
Diabetic Screening Services and the 2005 Expansion
Starting January 1, 2005, Medicare law expanded coverage to diabetic screening services. Some blood glucose testing covered under NCD 98 may be covered for screening purposes, subject to frequency limits. CMS directs billing teams to 42 CFR 410.18 and section 90, chapter 18, of the Claims Processing Manual for the full description of that screening benefit. Check those references for frequency and eligibility rules before billing screening tests — they operate under separate criteria from diagnostic testing.
Prior Authorization Under NCD 98
NCD 98 does not list specific prior authorization requirements for blood glucose testing. That said, your Medicare Administrative Contractor may have issued a local coverage determination with prior auth or pre-authorization requirements layered on top of the national policy. Check with your MAC before assuming prior authorization isn't required for high-frequency testing scenarios.
CMS Blood Glucose Testing Exclusions and Non-Covered Indications
The limitation on repeat testing for nonspecific presentations is the one that catches billing teams off guard. When a patient presents with nonspecific signs, symptoms, or diseases not normally associated with glucose metabolism disturbances, CMS covers a single blood glucose test. Repeat testing is not covered unless one of two things is true: the initial result was abnormal, or there was a change in clinical condition.
If repeat testing is performed in this scenario, a specific diagnosis code — CMS explicitly mentions diabetes as an example — must appear on the claim to support medical necessity. Submitting repeat tests without that diagnosis code is a direct path to claim denial.
The exception to this rule: repeat testing is covered when results are normal in patients with conditions that carry a confirmed, continuing risk of glucose metabolism abnormality. CMS gives glucocorticoid therapy monitoring as the example. If your patients fall into that category, document the specific condition and the ongoing risk in the chart.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Diabetes mellitus — management of hyperglycemia and hypoglycemia | Covered | Policy does not list specific codes | Document diagnosis and degree of control |
| Impaired fasting glucose (FPG 110–125 mg/dL) | Covered | Policy does not list specific codes | Confirm FPG range in documentation |
| Insulin resistance syndrome / carbohydrate intolerance | Covered | Policy does not list specific codes | Requires clinical documentation of condition |
| Hypoglycemia disorders (nesidioblastosis, insulinoma) | Covered | Policy does not list specific codes | Specific diagnosis should appear on claim |
| Catabolic or malnutrition state | Covered | Policy does not list specific codes | Document nutritional status |
| Tuberculosis, unexplained chronic/recurrent infections | Covered | Policy does not list specific codes | Single test likely; repeat requires abnormal result or change in condition |
| Alcoholism | Covered | Policy does not list specific codes | Single test likely without clinical change |
| Coronary artery disease (especially women) | Covered | Policy does not list specific codes | Single test likely without clinical change |
| Unexplained skin conditions (pruritis, ulceration, gangrene without established cause) | Covered | Policy does not list specific codes | Document absence of established cause |
| Symptoms possibly caused by glucose abnormality (coma, seizures, confusion, abnormal hunger/weight change, loss of sensation) | Covered | Policy does not list specific codes | Evaluate clinical context for repeat testing |
| Patients on medications affecting carbohydrate metabolism | Covered | Policy does not list specific codes | Glucocorticoid therapy specifically noted as example |
| Diabetic screening services (effective Jan 1, 2005) | Covered with frequency limits | See 42 CFR 410.18 | Separate frequency rules apply; see Claims Processing Manual Ch. 18, Sec. 90 |
| Stable, non-hospitalized patients — routine monitoring (no home monitoring) | Covered, up to 4x/year | Policy does not list specific codes | Frequency cap applies; document inability or unwillingness to home monitor |
| Nonspecific presentations — repeat testing without abnormal result or clinical change | Not Covered | Policy does not list specific codes | Repeat testing not medically necessary without abnormal result, diagnosis, or confirmed ongoing risk |
CMS Blood Glucose Testing Billing Guidelines and Action Items 2026
The medical necessity documentation burden in this policy is real. Here's what your billing team and clinical staff need to do before and after March 7, 2026.
| # | Action Item |
|---|---|
| 1 | Audit open claims and charge capture for frequency compliance. Pull all blood glucose testing claims for stable outpatients over the past 12 months. Flag any patient with more than four tests per year who doesn't have documentation of clinical factors justifying higher frequency. Fix the documentation before the claim goes out — or before an audit finds it. |
| 2 | Verify that repeat testing claims carry a specific diagnosis code. For any patient with nonspecific signs or symptoms, confirm the claim includes a specific diagnosis code (e.g., diabetes) when repeat testing was performed. A claim for a second or third test without that supporting diagnosis is a clean denial waiting to happen. |
| 3 | Document ongoing risk for normal-result repeat testing. If your clinicians repeat glucose tests in patients with normal results because of confirmed continuing risk — glucocorticoid therapy is the textbook example — the medical record must state the specific condition and the ongoing risk. Generic chart notes won't protect you on audit. |
| 4 | Check your MAC's local coverage determination. NCD 98 sets the floor. Your Medicare Administrative Contractor may have issued an LCD that assigns specific CPT or HCPCS codes, adds frequency limitations, or requires prior authorization for certain testing scenarios. Pull your MAC's LCD now and reconcile it against this updated NCD 98 before the effective date. |
| 5 | Separate diagnostic and screening test billing workflows. Diabetic screening services operate under different frequency rules than diagnostic glucose testing. Confirm your charge capture and billing guidelines distinguish between the two. Misbilling a screening test as diagnostic — or vice versa — creates reimbursement risk in both directions. |
| 6 | Train clinical documentation staff on the home monitoring documentation requirement. For stable outpatients who test up to four times per year, the policy requires documentation that the patient is unable or unwilling to do home monitoring. If your notes don't capture that, you don't have medical necessity on paper. Update your intake and visit documentation templates before March 7, 2026. |
| 7 | Loop in your compliance officer if high-frequency testing is a significant part of your payer mix. If blood glucose testing — especially repeat testing for complex diabetic patients — represents material revenue, have your compliance officer review your documentation protocols against this updated coverage policy before the effective date. The frequency and repeat-testing rules create audit exposure if your documentation isn't airtight. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Blood Glucose Testing Under NCD 98
NCD 98 does not list specific CPT, HCPCS Level II, or ICD-10-CM codes within the policy document. This is common for older national coverage determinations — the code-level specificity lives at the MAC level, in local coverage determinations.
What This Means for Blood Glucose Testing Billing
Your MAC's LCD is where you'll find the actual codes to use for Medicare blood glucose testing billing. Common codes used in this category — though not listed in NCD 98 itself — include laboratory codes for quantitative glucose assays and HCPCS codes for home blood glucose monitoring equipment. Do not assume codes are covered under NCD 98 without confirming against your MAC's LCD.
If you're using a clearinghouse or practice management system that auto-maps glucose testing claims to NCD 98, verify that the code-level mapping is based on your MAC's LCD, not just the national determination. A mismatch there is a common source of denials that billing teams don't catch until post-payment audit.
For diagnosis code guidance, the policy references diabetes mellitus, impaired fasting glucose, insulin resistance syndrome, hypoglycemia disorders, and the full list of conditions in the indications section. Your ICD-10-CM codes should match the clinical picture documented in the chart. Generic codes won't support the medical necessity argument if CMS or a MAC contractor reviews the claim.
If you're uncertain which codes to assign given no explicit code list in the policy, talk to your MAC's provider outreach and education team or your billing consultant before the effective date. Getting this wrong early creates a clean-up problem later.
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