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