I thought in this thread we found test strips are covered by Part B but in a way that makes it difficult. Test strips have to be obtained from the same vendor as CGMs because they are included in the $267.92 Medicare pays suppliers for a month supply of CGMs. Was I wrong?
@spdif Medicare used to say teststrips have to be bundled and then they would be covered under Part B. But the Dexcom isnât and hasnât been bundled for a while so⌠Unless someone has different information, as far as I know and experience with my supplier, the suppliers will not (bundle) and send you test strips with the Dexcom sensors.
Medicare has updated their verbage. Still somewhat confusing. But originally it happened with the approval of the G6. Dexcom made the push you donât need to check with fingersticks âbecause they are so accurateâ until you need to double check of course. So Medicare okayed coverage without needing to use finger stick as double checks and the suppliers didnât need to include test strips because you donât need them⌠until you do. Probably all part of cost savings to cover the G6 without the need then to cover test strips too.
I see what you mean. At this time I donât think a product that is a bundle is required. CPT Code A4293 is what the supplier submits for a CGM reimbursement claim.
A4239 SUPPLY ALLOWANCE FOR NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE
In the case of G6 the supplier is submitting the same code if they are sending sensor or sensors and a transmitter. This leads me to believe you should be able to get sensors, transmitters and test strips. At least if canât hurt to try.
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Except that Dexcom say this isnât necessary:
Halfway down the page:
Will Dexcom provide my diabetes testing supplies?
No. Blood glucose monitoring (BGM) supplies are not included in your CGM product shipments because Dexcom G6 and Dexcom G7 do not require fingerstick calibrations.* You must purchase any BGM testing supplies that you need for the future.
*If your glucose alerts and readings from the Dexcom G6 or Dexcom G7 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.
George Orwell came up with a word for this, âDoublespeak.â The Google AI provides a most accurate summary of what he meant under, âwhat does doublespeak mean in 1984â, but for those who wonât look:
In George Orwellâs â1984â, doublespeak refers to the intentional distortion or reversal of the meaning of words, often for deceptive or manipulative purposes.
doubleplusgood
So Dexcom explicitly say that the test strips are not part of the supplies because you donât need them then they explicitly say that you must use them if their product goes wrong.
This pretty much defines the word doublespeak.
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@spdif (on TUD, I assume that is the same spdif) recently sent me a link on another matter which documents the Medicare supply code (A4239):
For non-adjunctive CGMs, the supply allowance (A4239) also includes a home BGM and related supplies (test strips, lancets, lancing device, calibration solution, and batteries), if necessary. Supplies or accessories billed separately will be denied as unbundling.
So Dexcom is playing it fast and loose. Under Medicare Dexcom G7s and G6s should be âbundledâ (see the rest of the page) and include all items necessary; transmitter, sensor, receiver, and, if necessary a âhome BGMâ.
This makes complete sense! Otherwise it would be like supplying a wheelchair without wheels or, more likely, brakes.
Ya know, I really thought weâd already talked about bundling in this topic but turns out I avoided it. In this context bundling refers to coding for payments, not actual products. Best resource I could find when looking for a definition: https://www.cms.gov/priorities/innovation/files/fact-sheet/bundled-payment-fact-sheet.pdf
With that said, I was wrong, A4239 canât pay for test strips because
Federal Register :: Medicare Program; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy Issues, and Level II of the Healthcare Common Procedure Coding System (HCPCS); DME Interim Pricing in the CARES Act; Durable Medical Equipment Fee Schedule Adjustments To Resume the Transitional 50/50 Blended Rates To Provide Relief in Rural Areas and Non-Contiguous Areas
A blood glucose monitor and related supplies are necessary for patients using
adjunctive CGMs for accurate glucose measuring/testing purposes, while patients using a non-adjunctive CGM do not also need a blood glucose monitor.
Unless thereâs a newer regulation, Iâm not good at using the federal register.
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Itâs a complex sentence but it says the same thing as the text of the supplier code. Hereâs a breakdown:
A blood glucose monitor and related supplies are necessary for patients using
adjunctive CGMs for accurate glucose measuring/testing purposes,
The âblood glucose monitor and related suppliesâ are âfor accurate glucose measuring/testing purposesâ.
while patients using a non-adjunctive CGM do not also need a blood glucose monitor.
For that purpose. Itâs regular English, well, âwhileâ should maybe be âwhereasâ, but apart from that it is a single sentence and it justifies the rules explicitly disallowing provision of both a home BG test system and a ânon-adjunctionâ CGM system.
The actual supply code for the non-adjunctive CGM system explicitly permits provision of test strips (et al.):
Once again itâs a complex sentence but it does manage to pass as Plain English (as in plainenglish.co.uk and maybe plainlanguage.gov) The Medicare approach is in the next sentence I quoted:
So the DMEPOS has to supply the required test strips (etc) along with the other parts of the bundle (transmitters and sensors). Medicare wonât pay if they are supplied elsewhere (âunbundledâ) in the case of non-adjunctive CGMs. The test strips must also be necessary.
Hence my assertion that Dexcom are playing fastânâloose. The Abbott Libre systems started requiring test strip calibration (the Libre in 2014 then, three years later in the US, the 1a) just like the later Dexcom G5 in 2015. Both are ânon-adjunctiveâ, i.e. they may be used for treatment decisions. The word ânon-adjuctionâ is not Plain English.
Nevertheless because the devices could be used for treatment decisions (being non-adjunctive) the supplier was required to include the test strips in the order.
Then Abbott threw another spanner into the US cogs; the Libre 2 did not, could not, use test strips! Abbott made a big deal of this; now no test strips were required at all. Hence the words if necessary. Medicare are explicitly saying that CGM which do not require calibration will not get test strips, or, rather, trying to say that in a land where lawyers play with language the same way they play Racketball; Rackets and Balls.
So, of course, test strips are not necessary for either the G6 or G7; if you think you have to use a test strip to calibrate your G6 or G7 get a replacement, just as you have to do if your Abbott Libre 2 or Libre 3 is out of whack.