CMS Releases coverage criteria and billing codes for therapeutic Continuous Glucose Monitoring (CGM)

The CMS (Centers for Medicare and Medicaid Services) announced in the month of January that it would cover CGM (continuous glucose monitoring) for the very first time; particularly it would cover therapeutic CGMs, of which the only one presently recognized is the Dexcom G5. Officially, that coverage kicks in today, now that CMS has issues the billing codes providers can use to get reimbursed.

Dexcom president and CEO Kevin Sayer claimed in a statement, “This is a contemporary era and a major win for individuals with diabetes on Medicare who can benefit from therapeutic CGM. This decision supports the emerging consensus that CGM is the standard of care for any sufferer on intensive insulin therapy, regardless of age.”
A Continuous Glucose Monitoring (CGM) is therapeutic when its information can be utilized reliably for treatment decisions, as evaluated by the FDA. Presently, the mere device that meets this standard is Dexcom’s, others are pursuing it.
The latest codes have 4 requirements for reimbursement: that the sufferer has diabetes, that they have been utilizing a home glucose monitor and checking their glucose often, that they take insulin either several times each day or continuously through a pump, and that frequent adjusting is required by their insulin.
CMS will significantly cover a CGM if the data it is providing is essential to the day-to-day treatment of patient. In addition to that, consumer smartphones or tablets that are utilized to run the Dexcom app are explicitly not covered.