10/24/2023

A Big Win for CGM Patients and Suppliers: CMS to Allow for 90-Day Billing for CGM Supplies

Source: AAHomecare Alert 10/19/23

CMS published a change request (CR) directing DME MACs to adjust their local edits to allow for 90-day billing for continuous glucose monitor (CGM) supplies to align with blood glucose monitor supplies. The effective date of this change is January 1, 2024. The CR notes the change will be implemented by the Fraud Prevention System and UPIC. CMS will provide educational content to suppliers in a MLN Connects newsletter. 

“The 30-day billing requirement for CGM supplies was a source of confusion for patients and an unnecessary paperwork burden on suppliers and DME MACs,” said Tom Ryan, AAHomecare president & CEO.  “I appreciate the persistent work of our Diabetes Council and Regulatory Council in making the case for this common-sense change with regulators. This is a big win for CGM suppliers and their patients.”

AAHomecare’s Regulatory Council has been working on this issue for the past two years, and the Diabetes Council has made CGM billing a priority since the inception of that Council last year.  One example of this work is AAHomecare’s comments to CMS on a proposed LCD on CGMs in November 2022 (see page 6).  The change will reduce burden for suppliers and patients who are currently billing every 30 days for CGM supplies shipped every 90-days. AAHomecare thanks CMS for reviewing the industry’s request and making the change.  

See CMS' announcement here.

Oct. 19, 2023