If you are curious whether you qualify for CGM, read on to learn more.
What is a CGM?
A Continuous Glucose Monitor (CGM) can either work on its own (non-adjunctive) or need confirmation from a secondary monitor (adjunctive) before making diabetes treatment decisions.
As of February 28, 2022, the Centers for Medicare & Medicaid Services (CMS) classify both types of these monitors as Durable Medical Equipment (DME).
Who can get a CGM?
To get a CGM and its related supplies, customers must meet these conditions:
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They have diabetes (We refer to a specific list of diagnoses).
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Their doctor agrees that they (or their caregiver) are trained to properly use the CGM.
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The CGM is being used in the way recommended by the FDA.
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They meet one of these extra conditions: They're being treated with insulin, or they have a recorded history of severe low blood sugar levels. They're being treated with insulin daily, or they have a recorded and documented history of level 2 and level 3 hypoglycemic events.
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They've recently (within six months) seen their doctor in person or through telehealth services, who confirmed the above requirements.
For continued coverage, the user must consult with their doctor every six months to discuss their diabetes management and CGM use.
Important Information about Billing:
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When a CGM is covered, its related supplies are also covered.
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If any coverage conditions aren't met, the CGM and its supplies won't be covered.
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Supplies can be billed up to three times every 90 days. More than this will be denied.
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Non-adjunctive CGMs replace standard home blood glucose monitors (BGMs), and you can't bill for both.
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Adjunctive CGMs still require a secondary monitor and supplies for both can be billed separately.
Please refer to the specific guidelines and articles linked in the full policy for more detailed information.
Sources: CMS.gov Glucose Monitors
Binson's offers easy online ordering for your CGM supplies. Interested in getting started? Request your doctor send your RX to (586) 755-2322. Questions? Give us a call at (586) 755-2300 Ext 4749.
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