I just got word that today it’s official and emails will be going out in the near future to alert users to this fact. However, it is a REQUIREMENT that the RECEIVER be used in conjunction with a smart device. There will also be an email going out with a new Assignment of Benefits due to this change in coverage.
Im not on Medicare yet, but to me, it’s not a big deal to have the receiver - I’m already used to that now.
Here’s one authoritative source that communicates the new Medicare smartphone policy.
The source of this YouTube video is one of the Medicare DME MACs, CGS. The video is presented by Dr. Robert Hoover, Medical Director of CGS, one of the Medicare DME MACs.
Medicare published recently that their pending decision to allow use of a smartphone in conjunction with the Dexcom receiver will become effective when the Medicare DME MACs publish the decision. CGS is one of the two DME MACs, so I’m interpreting this YouTube video as triggering the effective date of this policy change announced on June 11, 2018.
I am concerned that CGS is only one of the two regional DME MACs. I thought that both DME MACs, CGS and Noridian would have both published the same announcement. Perhaps Noridian has and I’ve yet to find it.
Here’s the June 11 info posted on CMS.gov:
Durable Medical Equipment (DME) Center
Announcement of Important Changes Impacting Medicare Coverage of Continuous Glucose Monitors
Based on input from patients and other stakeholders, The Centers for Medicare & Medicaid Services (CMS) is announcing important changes in its written policies regarding how Medicare covers continuous glucose monitors (CGMs). These changes are consistent with the Agency’s approach of putting patients first and incentivizing innovation and use of e-technology.
CGMs are items of durable medical equipment (DME) that provide critical information on blood glucose levels to help patients with diabetes manage their disease. In January 2017, CMS issued a ruling providing for Medicare coverage of therapeutic CGMs. The ruling was followed by a policy article issued by the Durable Medical Equipment Medicare Administrative Contractors on March 23, 2017 to provide coverage guidance for these devices.
CMS heard from numerous stakeholders who shared their concerns that Medicare’s CGM coverage policy limited their use of CGMs in conjunction with their smartphones, preventing them from sharing data with family members, physicians, and caregivers.
After a thorough review of the law and our regulations, CMS is announcing that Medicare’s published coverage policy for CGMs will be modified to support the use of CGMs in conjunction with a smartphone, including the important data sharing function they provide for patients and their families.
The Durable Medical Equipment Medicare Administrative Contractors will issue a revised policy article in the near future, at which time the published change will be effective. [emphasis added]
Edited to add information published by Noridian, Medicare DME MAC on June 21, 2018.
Continuous Glucose Monitors - Use of Smart Devices
Joint DME MAC Article
Effective for claims with dates of service on or after June 7, 2018, the DME MAC Glucose Monitors Local Coverage Determination (LCD)-related Policy Article is being revised. The following information regarding the use of smart devices (watch, smartphone, tablet, laptop computer, etc.) in conjunction with a therapeutic continuous glucose monitor (CGM) will be incorporated into the Non-Medical Necessity Coverage and Payment Rules in an upcoming policy revision.
There is no Medicare benefit for supplies and accessories used with equipment that is not classified as DME. Coverage of a CGM system supply allowance (K0553) is available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. In addition, Medicare coverage is available for a CGM system supply allowance if a non-DME device (watch, smartphone, tablet, laptop computer, etc.) is used in conjunction with the durable CGM receiver (K0554). The following are examples of this provision:
Medicare coverage of a CGM supply allowance is available where a beneficiary uses a durable CGM receiver to display their glucose data and also transmits that data to a caregiver through a smart phone or other non-DME receiver.
Medicare coverage of a CGM system supply allowance is available where a beneficiary uses a durable CGM receiver on some days to review their glucose data but may also use a non-DME device on other days.
If a beneficiary never uses a DME receiver for a therapeutic CGM, the supply allowance is not covered by Medicare.
Smart devices are non-covered by Medicare because they do not meet the definition of DME (i.e., not primarily medical in nature and are useful in the absence of illness). Claims for smart devices must be billed using code A9270 (noncovered item or service).
Suppliers are encouraged to refer to the Glucose Monitors LCD and related Policy Articles for additional information on the coverage, coding and documentation requirements.
Last Updated Jun 21, 2018
Did they mention how they would enforce that unenforceable stipulation?
I think the only way someone will be denied Medicare coverage for a CGM is if they voluntarily admit to Medicare that they never use the Dexcom receiver. Given the numbers of Medicare beneficiaries who use the Dexcom G5 CGM system, it will only be a matter of time before someone blurts that out to Medicare. I could only hope that a sympathetic Medicare worker would choose “not to hear” that.
It wouldn’t be that hard to set up the G5 receiver on a night stand table and let it take you through the night. I’ve only used the G5 system for three months and I grew tired of acknowledging night-time alarms on both the receiver and smartphone. Maybe there’s a way to quiet one or the other but I didn’t figure it out. I reverted back to the G4 and am happy with it.
In general, when unenforceable rules are created that serve no purpose, it’s just kinda pointless and dumb.
Was the guy who came up with the original rule just too stubborn to admit they had made a mistake? So rather than make it simple and let people just pick their device, they come up with the “use both” rule.
It doesn’t matter to me, just curious why they would do it that way.
It’s the nature of any system of rules that may govern us. I’d like to think that broader language that includes instead of excludes would be a better system. Unfortunately, some human beings will try to game any bureaucracy to their advantage and to the disadvantage of the system. And I think career bureaucrats go nuts trying to stay one step ahead of them. I count my lucky stars I’m not caught in a bureaucratic job!
I don’t have any answer to make this better but I am happy that many seniors in this country will enjoy a better and safer quality of life due to this rule change.
Definitely a step in the right direction, so I should not complain that it isn’t perfect.
As I understand it, it’s not quite as dumb as it seems. It wasn’t a question of making up a rule but of how to interpret existing rules about what constitutes Durable Medical Equipment and how that gets paid for. A smartphone app is not exactly “DME” as usually conceived, whereas the receiver is. And if they’re paying for something–the receiver–they need (because Congress sez so, and you can see why they would) to ensure that it’s actually being used, otherwise they’re wasting pubic resources and funds on it. This is why CPAP machines are monitored as to whether the patient actually uses it. The rules obviously don’t fit this situation very well, but the reason for it isn’t quite as arbitrary and stupid as it looks from the outside.
For my part I like having both the receiver and the app–both of 'em lose connectivity from time to time, but rarely at the same time, so it’s handy to have the alternative.