By Quinn Phillips | Published November 9, 2020. These devices, which take glucose readings at regular intervals using a sensor that’s worn for several days in a row, were originally popular for people with type 1 diabetes — providing a safeguard against hypoglycemia (low blood glucose) and major glucose swings. Thanks to extensive advocacy by JDRF volunteers and staff, clinician support, and strong bipartisan support from Congress, in early 2017, the Centers for Medicare & Medicaid Services (CMS) determined that continuous glucose monitoring (CGM) devices that are approved for use in treatment decisions are eligible for Medicare coverage. The beneficiary has diabetes mellitus; and, 2. Right now, Medicare only covers “therapeutic” CGM systems, or those that don’t require confirming a reading using a traditional finger-stick test before making treatment decisions. That’s largely because many insurance providers, including Medicare, only cover CGM systems when they’re used to make diabetes treatment decisions, such as changing insulin doses or dietary choices. Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy may be able to obtain reimbursement if the following Medicare coverage criteria are met: The patient has diabetes; The patient has been using a home blood glucose monitor (BGM) and … Dexcom and Eversense XL CGMs, with their non-adjunctive status (no fingerstick) approval, would be the most expensive at $222.77 for the Dexcom G6 and $259.20 for the Eversense CGM supplies each month. A slew of smartwatches let people with diabetes monitor blood sugars from their wrist. The updated version of the company's system includes automatic alerts when the wearer's glucose is too high or too low. Medicare Establishes National Payment Rate for Eversense ® CGM System Eversense CGM to be reimbursed as a Physician Service November 12, 2019 04:03 PM Eastern Standard Time For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid services website. continuous glucose monitoring (CGM) systems. Abbott Laboratories’ ABT next-generation FreeStyle Libre 2 integrated continuous glucose monitoring (iCGM) system recently received Medicare coverage. If finalized into policy, it would take effect in April 2021 at the earliest. Criteria. Our website services, content, and products are for informational purposes only. Medicare Advantage members, you can request a copy of your Evidence of Coverage or Formulary if you need one. The Centers for Medicare and Medicaid Services (CMS) announced the proposed rule change on Oct. 27, 2020, and it was published the following week in the federal register. Want to learn more about CGM? Additionally, the Centers for Medicare and Medicaid DiabetesMine has the back story on artificial pancreas technology development -- everything you need to know. The turning point for the Medicare coverage, he says, came with the FDA approved label change allowing consumers to make dosing decisions based on the therapeutic testing results with the CGM. NOTE: Therapeutic CGMs provide information that can be used to make diabetes treatment decisions, such “We believe classification of CGMs in general is an important issue to address again… in rule-making.”. “With the policies outlined in this proposed rule, innovators have a much more predictable path to understanding the kinds of products that Medicare will pay for,” CMS Administrator Seema Verma said in a statement. Having met the codes for therapeutic CGM systems used for coverage by the U.S. Centers for Medicare & … By Dave Muoio. When the public comment period begins, diabetes advocacy groups will most likely encourage people to participate in this process. The Centers for Medicare & Medicaid Services (CMS) proposed a new rule on October 27, 2020 that would expand coverage of important diabetes management devices. However, about three months after the use of Medtronic CGM (still requiring fingerstick confirmations) would cost $198.77 per month for supplies, which factors in necessary test strips and subtracts the cost of those strips from what’s reimbursed for CGM supplies. This educational publication was produced and disseminated at U.S. taxpayer expense. — Read Medicare Advantage Plans May … This means people with diabetes covered by Medicare will have more choice in the type of diabetes technology they are able to use. Diabetes Self-Management offers up-to-date, practical “how-to” information on nutrition, exercise, new drugs, medical advances, self-help, and the many other topics people need to know about to stay healthy. 6. Abbott announced yesterday that its recently cleared FreeStyle Libre 2 integrated continuous glucose monitoring (CGM) system is now covered by the Centers for Medicare and Medicaid Services (CMS), and available to Medicare beneficiaries with diabetes who meet eligibility criteria. Have a diagnosis of diabetes, either type 1 or type 2 2. 11:36 am. Most Medicare drug plans have a coverage gap, (also called a donut hole). Read “CGM for Diabetes Management” and “How to Pick an Insulin Pump or CGM” and watch “Continuous Glucose Monitoring.”. • Committee approval date: April 21, 2020 • Accessed March 31, 2020 … Previously, most of these devices were not covered by Medicare plans. “For manufacturers, bringing a new product to market will mean they can get a Medicare payment amount and billing code right off the bat, resulting in quicker access for Medicare beneficiaries to the latest technological advances and the most cutting-edge devices available.”. According to a March 23, 2017 article from Medicare contractor CGS explaining the new coverage policy, "Coverage of the CGM system supply allowance is limited to those therapeutic CGM … Right now, Medicare only covers “therapeutic” CGM systems, or those that don’t require confirming a reading using a traditional finger-stick test before making treatment decisions. Medicare Coverage for CGMs and Other Devices Thanks to extensive advocacy by JDRF volunteers and staff, clinician support, and strong bipartisan support from Congress, in early 2017, the Centers for Medicare & Medicaid Services (CMS) determined that continuous glucose monitoring (CGM) devices that are approved for use in treatment decisions are eligible for Medicare coverage. Typically, proposed rule changes like this one end up being adopted, but they still need to go through a review process before they become official. This means they did not qualify for the coveted “non-adjunctive” label required by Medicare to approve coverage. Cite this: Medicare Spells Out CGM Coverage for Diabetes - Medscape - Mar 24, 2017. : After searching the Medicare Coverage Database, if no LCD/LCA is found, then use the above referenced policy.) Medicare now covers FreeStyle Libre that provides CGM or continuous glucose monitoring system in real-time. coverage for 2020, if you decide to. By Miriam E. Tucker . For some services, your PCP is required to obtain prior authorization from Aetna Medicare. Disclaimer Statements: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. All continuous glucose monitors (CGMs) may soon be covered by Medicare, if a new proposed federal rule is approved and takes effect. At present, only those on insulin have an opportunity for approval. The U.S. Centers for Medicare & Medicaid Services (“CMS”) reimbursement coverage has expanded the access of the Libre 2 to Medicare patients for better management of … Managing diabetes doesn’t mean you need to sacrifice enjoying foods you crave. Continuous Glucose Monitoring (CGM) CGM is proven and medically necessary for managing individuals with diabetes in the following circumstances: Short-term use (3-14 days) by a healthcare provider for diagnostic purposes. Let SelectQuote compare Medicare plans and navigate the complex Medicare changes in 2020. Does Medicare cover Dexcom G6? Coverage is subject to the specific terms of the member’s benefit plan. In addition, Medicare coverage is available for a To date, all CGM devices on the market with the exception of those from Medtronic Diabetes are covered by Medicare. CGM devices covered by Medicare under the DME benefit are defined in CMS Ruling 1682R as therapeutic CGMs. So far, most CGM users with type 2 have been people who take insulin. Medtronic praised this new policy proposal in a statement. Your PCP will issue referrals to participating specialists and facilities for certain services. About Eversense Beneficiaries who have continuous glucose monitors (CGMs), no longer need to meet their physician face to face for CGM, testing supplies and refills in order to maintain coverage. Implantable Continuous Glucose Monitors (I-CGM) (CPT codes 0446T and 0448T) • Medicare does not have a National Coverage Determination (NCD) for implantable September 02, 2020. That longstanding policy changed when the agency allowed for certain CGMs to be covered if they were deemed “therapeutic” — or cleared by the Food and Drug Administration (FDA) as accurate enough for use in treatment and dosing decisions, without a requirement for patients to take a fingerstick glucose test for confirmation. How do you stay positive and confident? Medicare Coverage Dental 2020 PDF download: Medicare and You National Handbook 2020 – Medicare.gov doctors who are in the plan's network. Medicare and CGM Coverage When the food and drug administration (FDA) gave the green light for people to make dosing decisions based on CGM results, Medicare began covering CGMs. DiabetesMine provides details on how to stay safe from the new coronavirus when you have diabetes. Medicare covers the treatment of type 1 or type 2 diabetes that involves intensive insulin therapy with multiple injections or the use of the pump on a daily basis. With access and affordability often the biggest hurdle to achieving better health outcomes, Medicare coverage is an important topic — especially since Medicare leads the way on what policies are adopted by private health insurers. The Dexcom G6 Continuous Glucose Monitoring (CGM) system is now available for eligible Medicare customers. Medicare Coverage for CGMs and Other Devices. But a recent announcement by Medicare could change that. As such, both adjunctive and non-adjunctive CGMs would be considered Durable Medical Equipment and thus covered by Medicare. COVID-19 has directly impacted Medicare coverage. IMPORTANT UPDATE: The Centers for Medicare & Medicaid Services (CMS) published an Interim Final Rule 1 on May 8th 2020 that they will not enforce the clinical criteria for continuous glucose monitors (CGM) during Covid19 public health emergency for Medicare patients with diabetes. The Medtronic Guardian 3 CGM may soon be covered by Medicare. All rights reserved. Continuous Glucose Monitors Therapeutic CGMs and related supplies are covered by Medicare when all of the following coverage criteria (1-6) are met: 1. When the food and drug administration (FDA) gave the green light for people to make dosing decisions based on CGM results, Medicare began covering CGMs. Yes. A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. Dexcom now ships Dexcom … “Beneficiaries are continuing to use adjunctive or ‘non-therapeutic’ CGMs to help manage their diabetes, and claims submitted for this equipment and its related supplies and accessories are being denied,” the CMS proposal states. The decision was put into effect in January 2017. If you are on Medicare, obtaining a CGM through your healthcare professional is a relatively involved process, requiring an in-person clinic visit, lab tests, documentation of frequent finger sticks (four or more times a day), and a lot of paperwork. A new proposed rule from the Centers for Medicare & Medicaid Services (CMS) would expand coverage for continuous glucose monitors (CGMs) under Medicare to include devices that aren’t approved for making treatment decisions. 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