May 26, 2021
Billing Reminder: Blood Glucose Monitor Supplies and Continuous Glucose Monitor Supplies - Switching
Recently, CGS, the DME MAC contractor for Jurisdictions B and C, has received inquiries regarding a beneficiary switching from continuous glucose monitor (CGM) supplies back to blood glucose monitor (BGM) supplies.
If a beneficiary wishes to return to BGM testing, they may do so, and Medicare will consider payment for BGM supplies and discontinue paying for CGM supplies. However, Medicare will not reimburse a new BGM monitor unless the CGM is past the 5-year reasonable useful lifetime (RUL). Beneficiaries can use a BGM monitor that they own or purchase a new monitor as an out-of-pocket expense.
Changing back to standard BGM testing and supplies is allowed without additional documentation of medical necessity, other than documentation of a diabetes diagnosis. However, we strongly recommend that the beneficiary consult their treating practitioner beforehand. Previously, this was not allowed without a change in medical necessity due to the 5-year RUL restrictions.
When a beneficiary switches from CGM supplies back to BGM supplies, a supplier must submit a claim for the BGM supplies. If the BGM supplies deny, the supplier will need to submit a redetermination. Once CGS confirms the beneficiary has switched back to a BGM, proper editing will be updated to discontinue allowance for the CGM supplies. Any future claims for BGM supplies can resume.
We encourage suppliers to utilize the myCGS web portal to search beneficiary claim history for same or similar items prior to claim submission for supplies. Suppliers can also utilize the Interactive Voice Response (IVR) (system). Press 1 for beneficiary information, then press 4 for diabetic supplies specific to beneficiary claim history.
As a reminder, Centers for Medicare & Medicaid Services (CMS) considers BGMs and CGMs to be same or similar equipment. The equipment is subject to the 5-year RUL restrictions on replacement. The BGM or CGM receiver is eligible for replacement prior to the 5-year RUL only if the item is lost, stolen, irreparably damaged, or if there is a change in medical condition.