Healthcare and Medical Coverage for Continuous Glucose Monitors

There is no doubt that Continuous Glucose Monitoring systems have revolutionized the way patients and healthcare providers deal with diabetes.

If you’re not familiar with the benefits of a CGM we’ll review them here.

One of the biggest obstacles to maximizing the many benefits associated with CGMs is price.

The other major obstacle is not having the right information.

Because of this, many diabetes patients are not maximizing the benefits available to them.

The good news is that Continuous Glucose Monitor coverage has seen many changes over the years, and they have become a reality that is well within reach for many patients living with the disease.

What is a Continuous Glucose Monitor?

Before we get started, let’s review what a Continuous Glucose Monitor does and how it helps.

A small electrode is placed under the skin and is held in place by an adhesive. Depending on the device, it could be placed on the back of the upper arm or on the abdomen. A transmitter attached to the electrode then sends data to a separate unit and takes readings on set intervals. A Continuous Glucose Monitor allows patients to record and access valuable information to help manage and control their diabetes, like daily patterns, ranges and targets. Patients and loved ones can even receive alerts when blood glucose levels are trending too high or too low.

What are the Benefits to Using a Continuous Glucose Monitor?

●??????Ease of Use – CGMs eliminate the need for inconvenient and painful fingersticks.

●??????24/7 Monitoring – Continual monitoring keeps patients safe and allows them to monitor levels anytime and anywhere.

●??????Data Collection – CGMs collect and store information to identify patterns that can be shared with healthcare professionals and caregivers to help avoid dangerous situations.

●??????CGMs are advanced, user-friendly, discreet and are continually evolving to make it easier for patients living with diabetes.?

●??????Identification and monitoring of extremes in blood glucose levels and assessment of nocturnal glucose patterns.

●??????Time in Range “TIR” of blood glucose results to determine if patients are meeting desired targets.

●??????Provides an analysis of the overall treatment plan and the data needed to identify if changes to the plan are needed.?

●??????Serves as a teaching tool for patients and healthcare providers to learn how factors, such as diet, exercise, and medication, can affect glucose levels.

Which Insurance Companies Cover Continuous Glucose Monitors?

The FDA approved the first CGM over 20 years ago and since that time rules for coverage have become more relaxed.

Today, most major health insurance plans provide some level of coverage for CGMs when prescribed by a qualifying physician. Some of the major insurance companies that cover Continuous Glucose Monitors are Cigna, United Healthcare, Blue Cross and Blue Shield, Aetna, Humana, and Kaiser.?

CGMs are considered durable medical equipment (DME) which is any type of medical device that serves a health care purpose. In order to qualify as a DME, the device must be prescribed for medical reasons and must be medically necessary in order to complete daily activities. DME’s must also be durable and withstand repeated use.

?Medicare Coverage of Continuous Glucose Monitors

Medicare is often overlooked as a viable option to cover the costs of Continuous Glucose Monitoring Systems (CGMs). That is due in part to the fact that until recently Continuous Glucose Monitors were not covered by Medicare.

Traditional fingerstick calibrations were considered the standard in making treatment decisions. As a result, CGMs were not considered medically necessary. Instead, Continuous Glucose Monitors were considered a cautionary and supplemental device and not classified under the durable medical equipment category. For this reason, CGMs were ineligible for Medicare coverage, and many patients who could have benefited from the use of a CGMs at an affordable price were unable to take full advantage.??

Thanks to recent changes, Medicare now covers many CGM brands under the durable medical equipment category. In 2017, Medicare made a change that began to open doors for CGMs and diabetes patients everywhere. The first major hurdle allowed certain CGMs to be covered by Medicare if they were deemed therapeutic.

Thanks to a ruling made by the FDA, certain CGMs were seen as accurate enough to be used in treatment and dosing without requiring a fingerstick for confirmation. That allowed the doors to continue to open and Medicare coverage increased to include CGMs smartphone usage.?

?By 2020, all but one CGM device on the market was covered. “As of October 2020, all CGM devices on the market with the exception of those from Medtronic Diabetes are covered by Medicare. These include the Dexcom G6, the Abbot FreeStyle Libre 1 and 2, and the implantable Eversense CGM from Senseonics.”1

?How to Find Out Which Continuous Glucose Monitors are Covered?

Sorting through the coverage and qualification process can be overwhelming. That’s where we can help! At Quest Health Solutions, we can guide you through the entire process. We are not only one of the leading suppliers of Continuous Glucose Monitors in the market today, but we also offer CGM Fulfillment Solutions.?Our experienced team will handle all of the paperwork, insurance and Medicare verification, billing and authorization calls. To learn more or to find out how a Continuous Glucose Monitor can be part of the solution, contact us 1-877-888-7050 Option 3, Ext. 1011, email [email protected] or schedule an appointment today.?

1. (2021) Healthline. Medicare Loosening Restrictions for Continuous Glucose Monitor Coverage. Available at https://www.healthline.com/diabetesmine/news-medicare-expanding-cgm-coverage#medicares-history-with-cgm accessed on 15 September 2021.