Consult appropriate health-care professionals before taking action based on this information. According to a March 23, 2017 article from Medicare contractor CGS explaining the new coverage policy, "Coverage of the CGM system supply allowance is limited to those therapeutic CGM … 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. By Quinn Phillips | Published November 9, 2020. Medicare’s current page on CGM insurance coverage states that “If you use insulin and require frequent adjustments to your insulin regimen/dosage, a CGM may be covered if your doctor determines that you meet all of the requirements for Medicare coverage.” Those requirements include not only which CGM system is being used, but the reasons why your doctor says it’s needed. As a result of the Affordable Care Act, the coverage gap will be considered “closed” in … Shoppers’ Medicare supplement insurance premiums increased to $160 per month for 2021 coverage, from $157 per month for 2020 coverage. “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs” isn’t a legal document. But any expansion of Medicare coverage for CGM is a positive step forward, according to authorities. But a recent announcement by Medicare could change that. The information provided on this Web site should not be construed as medical instruction. 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. 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. Strike the Spike II: How to Manage High Blood Glucose After Meals, COVID-19 and Diabetes: What You Need to Know About the Coronavirus. 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 fact is that patients are indeed using the Medtronic Guardian 3 sensor to make treatment decisions. The beneficiary has diabetes mellitus; and, 2. At SelectQuote, we want to alleviate any worry or stress you might have when it comes to Medicare changes in 2020. 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. 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. Medicare Patients Double check that you qualify for enrollment as a Medicare patient by calling 866.779.8512, texting “Medicare CGM” to 248.577.9903, or using the checklist below.Checklist of Medicare Coverage Criteria for CGM All of the following coverage criteria must be satisfied to qualify for Medicare coverage of Therapeutic CGMs and related supplies. That’s largely because many insurance providers, including Medicare, only cover CGM systems when they’re used to make diabetes treatment decisions, such as changing insulin doses or dietary choices. This educational publication was produced and disseminated at U.S. taxpayer expense. CMS approved reimbursement for the FreeStyle Libre 2 (Abbott), expanding access of the integrated CGM system, or iCGM, to Medicare beneficiaries with diabetes. 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. Medicare and CGM Coverage. A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. : After searching the Medicare Coverage Database, if no LCD/LCA is found, then use the above referenced policy.) © 2005-2020 Healthline Media a Red Ventures Company. Get the latest diabetes news and a free gift! That was referred to as a “non-adjunctive” designation. 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