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September 6, 2023

Did You Know the Treating Practitioner Must Conduct and Sign Any Follow Up Visits for Continuous Glucose Monitor (CGM) Coverage?

It has come to the attention of the DME MACs that clarification is needed regarding follow-up care for beneficiaries using a continuous glucose monitor (CGM). As noted in the Glucose Monitors Local Coverage Determination (LCD L33822), for continued CGM coverage, every six (6) months following the initial prescription of the CGM, the treating practitioner must conduct an in-person or Medicare-approved telehealth visit with the beneficiary to document adherence to their CGM regimen and diabetes treatment plan (emphasis added). For Medicare purposes, a pharmacist is not considered a statutorily recognized treating practitioner; therefore, a pharmacist entry in a beneficiary’s medical record does not meet the continued coverage requirements in the Glucose Monitors LCD. Please see the Standard Documentation Requirements for All Claims Submitted to DME MACsExternal Website for a clear definition on who qualifies as a treating practitioner.


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