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Medicare to Begin Covering CGMs…
But Are You “Worthy”?

After more than a decade of advocacy efforts, the Centers for Medicare & Medicaid Services (CMS) has recognized FDA-approved continuous glucose monitoring (CGM) devices as durable medical equipment, a significant step toward making them eligible for coverage under Medicare “Part B”.  The recognition follows a recent FDA announcement that the Dexcom G5 CGM system may be used as a replacement for fingersticks, as long as the system has been properly calibrated with fingersticks readings.

Although the benefits of regular CGM use have been known since 2008, CMS had previously refused to cover the devices under Medicare because they did not meet their definition of durable medical equipment.  Now that certain CGM systems are considered a replacement rather than an “adjunct” to fingersticks, that definition can be met.

Since Medicare has determined CGM devices are durable medical equipment, the program can now cover them on a case-by-case basis. Medicare beneficiaries should work with their health care professional and CGM provider to obtain coverage.  In most cases, coverage will be based on an individual’s risk of hypoglycemia and long-term complications, as well as the ability to use the system properly. 

Those applying should be ready to document as many of the following as possible:

  • The presence of hypoglycemia unawareness
  • A history of significant and severe low blood sugar episodes
  • An elevated HbA1c despite adherence with modern treatment methods
  • Ongoing self-monitoring of blood glucose via fingersticks
  • Self-management skills/education
  • Previous successful use of a CGM

By | 2017-01-18T19:43:13+00:00 January 18th, 2017|Diabetes Bites, January 2017 Newsletter|2 Comments

About the Author:

Integrated Diabetes Services is the worldwide leader in one-on-one consulting for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and the internet for children and adults.

2 Comments

  1. JJM January 24, 2017 at 7:07 pm - Reply

    OK – So another 4 years before I will be looking for Medicare CGM. Since the worst of my reasons for starting CGM are no longer evident, will I need to (hopefully be able to) acquire statements, records, etc that will be 8 to 15 years old and 3 to 5 doctors ago???
    Since I am under reasonable control with CGM – the toughest qualifications (episodes and A1C) are not currently met. So potentially I will need to return to ER via ambulance and have DMV threaten to take away my Dr License before PREVENTATIVE is covered.
    This is a giant step in the right direction anyway.

  2. Kim Scharff January 24, 2017 at 10:14 pm - Reply

    I not so small step for man; one giant leap for mankind. Yahooo!

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