Wiki Medicare Coverage for upgrading to CGM

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JillMedicalBiller

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Hello! Does anyone know if Medicare will cover a patient's CGM if they are upgrading from a BGM within the five year period?
Or does that fall under the Reasonable Useful Lifetime Same and Similar policy?
Thank you for any input on this! :)
 
I don't believe that the patient transitioning to a CGM from BGM would be limited by the 5-year RUL rule. I think it is similar to a patient transitioning from a manual wheelchair to a PWC due to a change in the patient's condition or status. Of course, you have to make sure that the patient meets the criteria laid out for the medical necessity of a CGM per LCD L33822 Glucose Monitors, which is for the Idaho DME MAC Noridian. I see a ton of Part C appeals that are upheld by the QIC for denial of a CGM for patients because they don't meet the criteria listed in the LCD so be certain that the patient meets ALL of the criteria laid out in the LCD.
 
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