The Centers for Medicare & Medicaid Services (CMS) has updated its documentation policy for replacement accessories for continuous glucose monitors (CGMs) owned by Medicare beneficiaries.
Effective Feb. 18, “[Medicare] contractors would not need to see the initial qualifying documentation, but will need to verify that medical need for continuing coverage, as prescribed in applicable policy (e.g., Local Coverage Determination) is met.”
As explained by the American Association for Homecare (AAHomecare) in a Jan. 22 email to stakeholders, “Effective February 18, 2025, contractors reviewing claims for CGM supplies will no longer need to verify that the original requirements for the CGM receiver were met. Once Medicare has paid for the CGM receiver, medical necessity for the receiver is considered established. A supplier only needs to provide medical necessity documentation for the on-going supplies. This aligns CGM policies with other DME items such as CPAP devices.”
In a Jan. 16 publication of Change Request 13049, CMS said the update was issued “to clarify the documentation required to support the replacement of essential accessories for beneficiary-owned CGMs.”
“In addition, the contractor shall ensure that the supplier’s record includes the reason why the accessory(s) need to be replaced to meet the Medicare beneficiary’s medical need,” the change request added. “The contractor shall also ensure that the supplier’s record includes the reason why any new accessories … need to be furnished to meet the Medicare beneficiary’s medical need. In regard to CGMs, we note that the contractor prescribed monthly allowance need not be documented to be taken into consideration by the reviewer (e.g., the CGM supply allowance is one unit of service per month).”
“The updated policy change will streamline coverage for beneficiaries and considerably reduce the administrative burden for suppliers,” AAHomecare said in its announcement. “AAHomecare has been working with the DME MACs and CMS on this issue over the last few months and thanks CMS for recognizing the challenges faced by suppliers and for listening to industry feedback in making this important change.”
