Is it true that the required 90 & 180 day endo appointments can be stretched up to 2 weeks more?
You can stretch them as long as you want but just don’t expect to get any insurance-covered supplies until you comply.
This is an issue that I am rapidly approaching, I will go on Medicare soon. What exactly are the rules pertaining to frequency of doctor visits and Medicare. I understand that in order to receive payment for pump supplies you must visit your doctor on a regular basis. What is the maximum days you can wait between visits, 90 days is a number I believe I have heard but I’m not sure about that.
Also, are there any other Medicare requirements other than for supplies?
Medicare requires that a patient be seen every 6 months for CGM coverage. For pump supplies it is 3 months (90 days). Most Medicare suppliers will not break those rules because they won’t get reimbursed by Medicare. Advantage plans can set their own rules. Plus since Omnipod is covered under Part D pharmacy benefits, Omnipod does not have the same 90-day requirement.
“Continued coverage of the insulin pump would require that the patient has been seen and evaluated by the treating physician at least every three months.”
I used to see my endo every 6 months prior to Medicare, but I dutifully see her every 3 months now. A waste of her time and my time and Medicare resources. But we like each other and the visits are fine.
This document is from 2004 but is still the current document for Medicare coverage of insulin pumps. The requirements are about halfway down in the document in section A5.
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