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Diabetes Covered Benefits

Please use the following list as a resource for the benefits covered for First Choice members with diabetes. If you have any questions, please call Provider Services at 1-800-741-6605.

Diabetes education

  • Diabetes education is a covered benefit for all members.
  • To qualify for coverage, the provider must be a certified diabetic program educator (DPE) or a Department of Health and Environmental Control (DHEC) office.
  • No authorization is required if the provider is participating and is DPE-certified or a DHEC office.
  • Diabetes education is not covered if it is performed by a nonparticipating or non-DPE-certified provider.
  • For a list of DPE-certified providers, go to our Provider Directory and search for a diabetic program educator.
  • Providers must use specific CPT codes for diabetic education.

Diabetes supplies

Blood glucose meter (glucometer)

  • There is a maximum of one meter per year (plus one meter for school, if designated on the prescription).
  • Please make sure to select from the list of covered glucose meters. Selecting a noncovered reader may result in additional out-of-pocket costs for First Choice members. The following meters are covered:
    • ACCU-CHEK® Aviva Plus meter.
    • ACCU-CHEK® Nano SmartView meter.

Lancet strip

  • Insulin taking: maximum of 100 strips per month.
  • Gestational diabetes: maximum of 300 strips per month.
  • Non-insulin taking: maximum of 50 strips per month.

Lancing device

  • There is a maximum of one device every six months (plus one device for school, if designated on the prescription).

Ketone urine test strips

  • This is covered as a durable medical equipment (DME) benefit. These are limited to two 100-count boxes a month (HCPC code A4250). DME items are covered with a prescription or order and a certificate of medical necessity from the primary care provider (PCP) or prescribing provider when presented to a participating DME provider.
  • A copay applies to members ages 19 and older. Please refer to the copayment reference guide (PDF) for a list of current member copays. There is no copay for members who are pregnant or under age 19.

Insulin pumps

  • Insulin pumps are a covered DME benefit for members with type 1 diabetes only.
  • DME items are covered with a prescription or order and a certificate of medical necessity from the PCP or prescribing provider when presented to a participating DME provider.
  • A copay applies to members ages 19 and older. Please refer to the copayment reference guide (PDF) for a list of current member copays. There is no copay for members who are pregnant or under age 19.

Dilated eye exams

  • This is a covered benefit for members with diabetes regardless of age, and it includes refractions. No prior authorization is required.

Podiatry services

  • Podiatry services must be billed by a podiatrist.
  • Services are covered for members of all ages; however, members over the age of 21 must have a diagnosis of diabetes.

Diabetic shoes

  • Diabetic shoes are a covered DME benefit for members with diabetes. Members can receive one pair per year.
  • Prescriptions for diabetic shoes must be signed by a doctor (M.D. or D.O.).
  • DME items are covered with a prescription or order and a certificate of medical necessity from the PCP or prescribing provider when presented to a participating DME provider.
  • A copay applies to members ages 19 and older. Please refer to the copayment reference guide (PDF) for a list of current member copays. There is no copay for members who are pregnant or under age 19.

Home health care

  • Physician-ordered home health care is covered when it is determined to be medically necessary.
  • First Choice members are not required to be homebound to receive home health care services.
  • Prior authorization is required through Utilization Management after the sixth visit.
  • Home health care services include:
    • Home health aides (HHAs).
    • Occupational therapy.
    • Physical therapy.
    • Skilled nursing.
    • Speech therapy.