Providers race to get physicians up to speed on CGMs 

YARMOUTH, Maine – Diabetes providers are striving to fill an information gap for referral sources who may not be familiar yet with changes to Medicare policy that expanded coverage for continuous glucose monitors (CGMs). 

“Some (referral sources) are off to the races, but there’s a large number of members of the medical community that don’t know (about the changes),” said Matt Gallagher, CEO of Utah-based JQ Medical. “I think the industry is working through the process of getting the information out there, as physicians become aware of the different therapies.” 

CMS in March implemented new guidelines that, among other things, expand coverage for CGMs to include beneficiaries with Type 2 diabetes. 

Providers are simultaneously getting themselves and referral sources up to speed – it's a learning curve all around, says Peyton Brown. 

“We’re trying to get the physicians trained – we’ve got all our sales reps and pedorthists trained on teaching them what the rules are as far as the different insurances go,” said Brown, vice president of The Diabetic Shoppe in Charleston, Miss. “That’s been a challenge.” 

Providers say referral sources are receptive and the changes have already led to an uptick in the number of prescriptions for CGMs. 

“Whenever they expand access to Type 2, that increases the market,” said Tim Cady, president of California-based Advanced Diabetes Supply. “It also increases the number of doctors that are willing to prescribe. We’ve seen more and more general practitioners and internal medicine practitioners adopt CGM and start prescribing it for their patients, not just endocrinologists.”  

The new HCPCS codes for CGMs that went into effect Jan. 1 are still a challenge. For example, in Mississippi, Medicaid has just this month added the new codes, says Brown. 

“We haven’t been able to bill them for six months,” she said. “And we still have insurances that we have to keep sending claims back to for reprocessing. But I think that will all level out.” 

Given the rapid advances in diabetes technology, it’s going to be critical for providers to get used to “change management communication” like this, says Gallagher.  

“We’re all scrambling to become more well-versed in that space,” he said.