medicare cgm coverage 2020

However, about three months after the use of CGM also didn’t fall under the “Durable Medical Equipment” category that covers other diabetes devices and supplies, therefore it wasn’t eligible for Medicare coverage. Thank You, Smartwatches: Monitoring Diabetes from Your Wrist, Artificial Pancreas: What You Should Know, Two New Continuous Glucose Monitors in the Works, Everything You Should Know About COVID-19 and Diabetes. This process involves soliciting comments from the public on the proposed rule, which will be considered in the agency’s final decision. By Quinn Phillips | Published November 9, 2020. Type 1 diabetes advocacy organization JDRF praised this move; it’s a policy change the org has been pushing toward for years. Have a diagnosis of diabetes, either type 1 or type 2 2. Shoppers’ Medicare supplement insurance premiums increased to $160 per month for 2021 coverage, from $157 per month for 2020 coverage. All continuous glucose monitors (CGMs) may soon be covered by Medicare, if a new proposed federal rule is approved and takes effect. Among other things, it sends a signal that new technologies are welcome. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid services website. Previously, most of these devices were not covered by Medicare plans. 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. Today, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS), is proposing new changes to Medicare Durable Medical Equipment, Prosthetics, Orthotic Devices and Supplies (DMEPOS) coverage and payment policies. DiabetesMine reports on future CGM devices from Ascensia Diabetes and WaveForm Diabetes, on the heels of the 2019 JP Morgan Healthcare conference. Our website services, content, and products are for informational purposes only. These include the Dexcom G5 and G6 models, the Abbott FreeStyle Libre 1 and 2, and the implantable Eversense CGM from Senseonics. For the older adult population, Sayer says, ''the sensor is giving you a tool that the body loses. The coverage includes two CGM systems: Abbott’s FreeStyle Libre that provides real-time monitoring of blood glucose levels and Dexcom’s G5. 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. To get cutting-edge diabetes news, strategies for blood glucose management, nutrition tips, healthy recipes, and more delivered straight to your inbox, sign up for our free newsletter! © 2005-2020 Healthline Media a Red Ventures Company. “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.”. Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. If finalized, this proposed regulation would expand Medicare coverage to all FDA-authorized continuous glucose monitors (CGMs) beginning on April 1, 2021. This educational publication was produced and disseminated at U.S. taxpayer expense. Medicare Coverage for CGMs and Other Devices. MEDICAL CRITERIA Not applicable PRIOR AUTHORIZATION BlueCHiP for Medicare and Commercial Products Not applicable POLICY STATEMENT BlueCHiP for Medicare Continuous glucose monitoring (CGM) devices defined as “therapeutic” CGMs are covered. Want to learn more about CGM? 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. We are therefore looking forward to working with CMS on this important initiative.”. But the proposed new rule would classify all CGM systems — not just “therapeutic” ones — as durable medical equipment covered by Medicare, with payment amounts established for the devices and their associated accessories and supplies. Most Medicare drug plans have a coverage gap, (also called a donut hole). Medicare has adamantly refused in the past to cover CGM sensors, receivers and transmitters claiming they are simply “convenience items” and did not qualify for coverage. “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. Coverage is subject to the specific terms of the member’s benefit plan. CMS admits that it really is just embracing what’s going on in the real world. Diabetes-Themed Holiday Gifts: Should You or Shouldn’t You? A year later in 2018, Medicare began also covering smartphone use with CGMs — something its previous policy change didn’t address, but left Medicare beneficiaries unable to access the latest CGM devices with smartphone connectivity as part of their core function. The decision was put into effect in January 2017. In addition, Medicare coverage is available for a The new proposed rule, if enacted, would replace the 2017 policy. As such, both adjunctive and non-adjunctive CGMs would be considered Durable Medical Equipment and thus covered by Medicare. Medicare and CGM Coverage. Last Updated: December 7, 2020. Yes. 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. "We are very pleased access to Eversense has been expanded to a large number of Medicare patients by these LCDs. As a result of the Affordable Care Act, the coverage gap will be considered “closed” in … : After searching the Medicare Coverage Database, if no LCD/LCA is found, then use the above referenced policy.) “Broadening Medicare coverage in this way will be better able to accommodate for the future of this important technology for people with T1D.”. While Medicare would allow for coverage on any FDA-cleared CGM going forward, the pricing for Medicare members would be adjusted based on the adjunctive / non-adjuctive categorization. The coverage ruling saves people between $2,500 to $4,000 a year who might otherwise purchase the equipment out of pocket. DiabetesMine explores whether it's advisable to give someone with diabetes a holiday gift related to their disease — or rather not? 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. • Committee approval date: April 21, 2020 • Accessed March 31, 2020 … If you kept your existing coverage and your plan’s September 02, 2020. In addition, the elimination of some coverage … • Most plans offer extra benefits that. CMS approved reimbursement for the FreeStyle Libre 2 (Abbott), expanding access of the integrated CGM system, or iCGM, to Medicare beneficiaries with diabetes. This achievement marks a … Medicare Coverage Dental 2020 PDF download: Medicare and You National Handbook 2020 – Medicare.gov doctors who are in the plan's network. The information provided on this Web site should not be construed as medical instruction. Medicare has adamantly refused in the past to cover CGM sensors, receivers and transmitters claiming they are simply “convenience items” and did not qualify for coverage. The latest delivered straight to your inbox. 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. Up until early 2017, CMS did not cover CGM use because the agency considered it to be “precautionary,” meaning CGMs were classified as a supplemental type of device that were not considered medically necessary. This means after you and your drug plan have spent the initial coverage limit ($4,020 in 2020), you are responsible for paying a percentage of the plan’s Medicare Coverage for Libre 2 Boosts Abbott's CGM Prospects Zacks Equity Research September 03, 2020 HOLX Quick Quote HOLX QGEN Quick Quote QGEN ABT … It’s not a guidance document. About Eversense 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. 6. Medicare now covers FreeStyle Libre that provides CGM or continuous glucose monitoring system in real-time. Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision Download the … DiabetesMine shares its monthly list of favorite social media posts for December 2020. Together these three MACs provide coverage for more than 18 states, including areas of high Medicare coverage concentration and serve approximately 20 million beneficiaries. 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 … Last week, the U.S. Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicare, announced a proposed rule that would expand access to CGM systems under the program, as noted in an article at MedPage Today. So far, most CGM users with type 2 have been people who take insulin. Most Medicare drug plans have a coverage gap, (also called a donut hole). The beneficiary has diabetes mellitus (Reference the ICD-10 Codes that Support Medical Necessity section for applicable diagnoses in LCD L33822) 2. Use a home blood glucose monitor (BGM) and conduct four or more daily BGM tests 3. This means after you and your drug plan have spent the initial coverage limit ($4,020 in 2020), you are responsible for paying a percentage of the plan’s cost for covered brand name and generic prescription drugs while in the coverage gap. Medicare covers therapeutic continuous glucose monitors (CGMs) and related supplies instead of blood sugar monitors for making diabetes treatment decisions, like changes in diet and insulin dosage. 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 CGM system may be considered medically necessary when ONE of the following criteria are met: Individual has type 1 diabetes and is receiving short- or rapid-acting insulin therapy or Individual has type 2 diabetes and is receiving short- or rapid- acting insulin therapy or Healthline Media does not provide medical advice, diagnosis, or treatment. 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. 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. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy. To date, all CGM devices on the market with the exception of those from Medtronic Diabetes are covered by Medicare. Additionally, CMS will not enforce Medicare’s coverage policy’s clinical indication requirements, including the requirement that beneficiaries must perform SMBG 4 or more times a day. Coverage of a CGM system supply allowance (K0553) is available for those therapeutic CGM systems where the member uses a receiver classified as DME to display glucose data. CGM has truly been a reimbursement success story. Generally, you must get your health care coverage from your primary care physician (PCP). 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 The beneficiary has diabetes mellitus; and, 2. Medicare Coverage for Libre 2 Boosts Abbott's CGM Prospects Zacks Equity Research September 03, 2020 HOLX Quick Quote HOLX QGEN Quick Quote QGEN ABT Quick Quote ABT TNDM Quick Quote TNDM Diabetes can have a big impact on your body image. In explaining its proposal to change the rules, the agency writes that “CGMs that are not approved for use in making diabetes treatment decisions can be used to alert beneficiaries about potentially dangerous glucose levels while they sleep,” a worthy benefit even if the person has to confirm their reading with a finger-stick test before taking corrective action. Additionally, the Centers for Medicare and Medicaid Services have stated that they do not meet the official definition of durable medical equipment, which keeps them falling under the DME category. 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. CGM devices covered by Medicare under the DME benefit are defined in CMS Ruling 1682R as therapeutic CGMs. “We believe classification of CGMs in general is an important issue to address again… in rule-making.”. If you think you might benefit from using a CGM system but don’t currently use one, talk to your doctor about the potential burdens and benefits, along with how to navigate insurance coverage — including whether it might be best to wait until the proposed Medicare rule change becomes official. 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 … The updated version of the company's system includes automatic alerts when the wearer's glucose is too high or too low. You are eligible for Medicare coverage of outpatient therapy services if: You need skilled therapy services, and the services are considered a safe and effective treatment for you. Getty . Publish date: November 9, 2020. But any expansion of Medicare coverage for CGM is a positive step forward, according to authorities. “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. No doubt, the biggest issue for CGM users on Medicare will be the number of CGM sensors allotted each month, as this has been a big issue in the past, with people struggling to get coverage for the full amount they need. continuous glucose monitoring (CGM) systems. This includes returning to Original Medicare or joining a Medicare Advantage Plan. 2020 Continuous Glucose Monitoring (CGM) Coding Reference and Frequently Asked Questions Refer to the chart below for billing codes for CGM. For some services, your PCP is required to obtain prior authorization from Aetna Medicare. For years now, continuous glucose monitoring (CGM) systems have become a growing mainstay of diabetes management. 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. “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs” isn’t a legal document. ICN MLN909465 September 2020 Medicare covers therapeutic CGMs and related supplies when you meet all of the following coverage criteria: 1. JDRF has launched T1Detect, the first-ever home screening kit for risk of type 1 diabetes. 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. Be treated with insulin with multiple daily injections or a constant subcutaneous infusion (CSI) pump 4. But CGM systems are becoming increasingly popular for people with type 2 diabetes, as well. Practically speaking, the only major change would be now covering the Medtronic CGM, the only only CGM that hasn’t previously obtained the “non-adjunctive” designation that all of its competitors already have. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is covered by Medicare for patients who meet the Medicare coverage criteria. There are established CPT codes for providers to get paid and broad coverage within the payer community. 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. Medicare Advantage members, you can request a copy of your Evidence of Coverage or Formulary if you need one. The Dexcom G6 Continuous Glucose Monitoring (CGM) system is now available for eligible Medicare customers. 11:36 am. “CGM technology has and will continue to advance and mature, and it is important that regulations remain flexible to be able to accommodate these future advances,” said JDRF CEO Dr. Aaron Kowalski, who lives with T1D and is a long-time CGM user himself. But a recent announcement by Medicare could change that. Refer to the Non-Medical Necessity Coverage and Payment Rules in the LCD-related Policy Article for additional NOTE: Therapeutic CGMs provide information that can be used to make diabetes treatment decisions, such : After searching the Medicare Coverage Database, if no LCD/LCA is found, then use the above referenced policy.) Die CompuGroup Medical Deutschland AG ist eine Tochtergesellschaft der CompuGroup Medical SE & Co. KGaA, einem weltweit führenden eHealth Unternehmen. 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