Continuous Glucose Monitors (CGMs) Questions & Answers
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- Can the medical records for the six-month continued coverage visit come from any treating practitioner? Are they required to be from the treating practitioner who originally prescribed the CGM?
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Any treating practitioner familiar with the beneficiary’s diabetes treatment plan and able to document their compliance and adherence can conduct the visit.
Originally published: 03.27.24
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- Is an order enough documentation that the beneficiary (or caregiver) has sufficient training using the CGM?
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Yes, per criterion 2 in the Glucose Monitors Local Coverage Determination (LCD) (L33822): “The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the CGM prescribed as evidenced by providing a prescription”.
Originally published: 03.27.24
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- If a patient misses their six-month follow-up appointment, is there a grace period? Are there other acceptable reasons or documentation to allow for continued coverage of their supplies?
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Unfortunately, there is no specific grace period. The continued coverage visit must happen at least once every six months. Please remember the practitioner can also conduct this follow-up visit through Medicare-approved telehealth. If the visit is late, continued coverage of supplies can resume on or after the date of the visit.
Originally published: 03.27.24
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- For a 90-day supply, is the six-month visit based on the “from” date of service or the end of the billing period (“to” date of service)?
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Medicare requires continued coverage documentation within 6 months prior to the “from” date of service on the claim.
Originally published: 03.27.24
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- Will Medicare continue coverage of CGM supplies for patients who first qualify based on insulin use but no longer meet that criterion at the six-month visit? For example, they no longer use insulin.
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Every six months after the initial prescription, the treating practitioner must conduct an in-person visit with the beneficiary. This visit must document adherence to their CGM regimen and diabetes treatment plan. Medicare does not require the treating practitioner to reconfirm the initial coverage criteria. The follow-up visit can also be through Medicare-approved telehealth.
Originally published: 03.27.24
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- What are the coverage criteria if the beneficiary has a history of problematic hypoglycemia?
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See the Glucose Monitors LCD (L33822) for the coverage criterion 4B. The associated documentation requirements are published in the Glucose Monitors Policy Article (A52464).
Originally published: 03.27.24
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