Avoid Denials: Why CGM Coverage Hinges on Receiver Use

Pop quiz. Does Medicare cover continuous glucose monitor (CGM) supplies when a patient uses their smartphone or tablet exclusively to view the CGM data?

No, they do not.

Many suppliers are surprised to learn that Medicare only covers CGM supplies when the patient uses a dedicated CGM receiver – HCPCS E2102 or E2103 – at least once during each billing month.

Medicare doesn’t have a minimum use requirement for dedicated receivers, per se, but to secure reimbursement for CGM supplies, patients must have a qualifying device and use it regularly. Patients may prefer smart phone interfaces and can certainly use those, too … just not exclusively.

Confirm the Patient has a Dedicated CGM Receiver Before the First Supply Shipment

Since supply reimbursement is dependent on the patient having a qualifying device, it makes sense to ensure they have one before shipping any CGM supplies. There are two ways to do that:

• Deliver a qualifying device to the patient, or
• Confirm and document they already have one.

There are two ways to find out if the patient has an existing device:

• Search Medicare’s records for same or similar billing, or
• Obtain a written or verbal attestation from the patient.

Document the Patient Uses their Dedicated CGM Receiver

It is not enough that the patient possesses a dedicated receiver. Suppliers need to confirm they use it one or more times during each billing cycle. The best way to do so is to include a question in the routine re-supply interview and document the answer in the patient’s file.

If the patient has not used their receiver to view their CGM data, suppliers must secure a valid ABN and include the appropriate ABN modifiers when billing any resupply allowances.