CMS responds to pushback on CGMs

WASHINGTON – CMS recently clarified who can conduct follow-up visits every six months for continuous glucose monitors. 

While some states have begun to pass laws that increase the role of pharmacists in prescribing and treating patients, Medicare does not recognize them as a treating practitioner, so “a pharmacist entry” in the patient’s record would not meet coverage requirements in the local coverage determination for CGMs. 

“Some of the DME community was pushing back because the pharmacist was doing the follow up and they are not a licensed practitioner in Medicare, so the visit won’t count,” said Linda Langiotti, senior vice president of strategic channels for CCS Medical, and chairwoman of the AAHomecare Diabetes Council. “It caused a lot of confusion and frustration in those markets.” 

When it comes to CGM guidelines – which were updated in April to expand coverage to more beneficiaries to expand access – providers are careful to follow them, says Liz Decker, manager of diabetes customer service for Binson’s Medical Equipment and Supplies. 

“We would not take a pharmacist office visit for either a startup or compliance CGM,” she said. “I don't know if I have seen any instances where they are following up with a pharmacist rather than their physician. I do think guidelines are much easier to follow for CGMs than blood glucose monitors.” 

As the CGM category and coverage guidelines continue to evolve, the Diabetes Council, which met in early October, is committed to keeping communication open with CMS and other payers, says Langiotti. 

“We’re very excited about the growth in the provider community that is committed to working together,” she said.