Glucose Monitor - Policy Article

Home BGMs and CGMs are covered under the DME benefit when LCD reasonable-and-necessary and Medicare statutory requirements are met; therapeutic (non-adjunctive) CGMs are explicitly covered and adjunctive CGMs may be classified as DME. Coverage of CGM supply allowances (A4238/A4239) requires use of a durable receiver or pump (or a durable receiver plus non-DME device) and PDAC listing for devices billed as E2102/E2103; devices that are smartphone-only or otherwise not DME are non-covered and multiple listed supplies are denied as unbundling. Documentation requirements include PDAC/PCL verification, prior face-to-face and Written Order Prior to Delivery when required by Final Rule 1713, and specified medical-record evidence (visits, testing logs, training, FDA indication, and hypoglycemia event documentation) for initial CGM provision and for utilization exceeding usual amounts.

"Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit when the device and use meet the related LCD reasonable-and-n..."