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Medicare Coverage of CGM

 Medicare Coverage of CGM


With an all too familiar approach, the US Centers for Medicare and Medicaid Services (CMS) has handed HME providers another double edged sword. With great excitement, HME News reported in late January that CMS had approved CGM (Continuous Glucose Monitors). The Dexcom G5 is currently the only CGM to meet CMS’s primary qualifying definition (approval by the FDA for use in place of a blood glucose monitor for making diabetes treatment decisions).

The CMS decision to grant CGM Medicare coverage gave consideration to the sustained advocacy and relentless activism on this topic by a coalition of groups. However, even though rates have been proffered, the coverage does not currently exist.

Now the second edge of the sword.  The fee schedule extended by CMS for the new CGM classification does not appear to be adequate compensation. In its CGM ruling, CMS set a one-time fee of $236 to $277 for the CGM receiver, and a monthly allowable of $248.38 for related accessories.

Regardless of the financial outlook, this is an important first step towards adding a life changing technology to a Medicare patient’s diabetes treatment plan. Dexcom is currently working with CMS to revise the allowable so that servicing Medicare patients is financially viable.

As an authorized Dexcom wholesale provider, look to DDP Medical Supply for information and to support your Dexcom needs.


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