Medicare Lifts 4 Times a Day Restriction on CGM Coverage
The Centers for Medicare & Medicaid Services (CSM) have taken an important step to make continuous glucose monitoring (CGM) more accessible for Medicare beneficiaries with diabetes. The Medicare Administrative Contractors (MACs) who oversee the policies for durable medical equipment recently released update clinical coverage criteria for CGM devices. This updated criteria takes effect on July 18, 2021 and includes the following:
- Eliminates the four times per day testing requirement to qualify for a CGM device.
- Allows for individuals using multiple daily administrations (updated from injections) of any insulin, which helps to provide a coverage pathway for people using inhaled insulins.
- Removal of “Medicare-covered” from continuous subcutaneous insulin infusion (CSII) pump criterion language for CGMs
- Clarification of coding verification language for products billed as K0554
- Revision of 5 minutes for measuring interstitial fluid of glucose content by a CGM devise to 1 minute
Kate Thomas, Chief Advocacy and External Affairs Officer of the Association of Diabetes Care & Education Specialists (ADCES), notes, “This updated Local LCD was a direct result of coordinated advocacy efforts among patient and provider groups, as well as industry partners, coalitions and other entities.” Thomas adds, “Our work is not done. We know there are more changes that must be made and ADCES is working with the Diabetes Technology Access Coalition (DTAC)* to push for additional improvements, including removing the requirement for multiple daily injections of insulin to qualify for a CGM device.”The American Diabetes Association (ADA) praised the announcement, calling it a “big win for the diabetes community” and tweeting, “The removal of this criterion has been an effort long-led by the ADA, on which we have been actively engaged with CMS. People with diabetes on Medicare will now be able to more easily access this critical piece of technology, leading to better diabetes management and better health outcomes.”
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