Billing change better aligns CGM supplies with other supplies

WASHINGTON – CMS recently published a change request directing the DME MACs to allow 90-day billing for continuous glucose monitor supplies – a big win for all diabetes stakeholders. 

Currently, while providers are shipping 90 days' worth of CGM supplies, they must bill for them monthly, causing “tremendous confusion” among providers and beneficiaries, says Linda Langiotti, senior vice president of strategic channels for CCS Medical, and chairwoman of the AAHomecare Diabetes Council. 

“Some thought it was fraud: ‘Why am I getting three bills for my one order,’” she said. “We’ve had beneficiaries saying, ‘You want to monitor my usage of supplies; don’t you know what you sent me?’ It really caused industry confusion, patient confusion and a lot of complaints to Medicare.” 

In this fast-moving product category, CMS also recently clarified who can conduct follow-up visits every six months for CGMs.   

The billing change, which is effective Jan. 1, will better align CGM supplies with other supplies like test strips and lancets, which have traditionally been billed at 90-day intervals. 

“Some of the diabetes patients also use insulin pumps and/or CPAP medical devices, which are already on 90-day billing/supply shipments,” said Bill Mixon, CEO of Advanced Diabetes Supply. “Since this can now include CGM, it will simplify the billing process. ADS was already shipping a 90-day supply four times a year to Medicare beneficiaries, so the only difference our Medicare patients will see is that they will now be billed four times versus 12.” 

The reduced administrative burden will allow more time for patient care, says Mixon. 

“We will also be able to shift the deployment of some resources internally to continue our focus on improving outcomes of patients living with diabetes with our certified diabetes care and education specialist program and our collection of A1c data with payers to track the progress of their members,” he said. 

Billing for CGMs is an issue that’s been at the top of the to-do list for the AAHomecare Diabetes Council – and for Langiotti, who’s been working on the issue for four years. 

“I applaud CMS,” she said. “They genuinely listened and asked questions to understand what the burden was across all the communities. It’s a big win for the community.”