Continuous Glucose Monitors – Use of Smart Devices
Joint DME MAC Article
Effective for claims with dates of service on or after June 7, 2018, the DME MAC Glucose Monitors Local Coverage Determination (LCD)-related Policy Article is being revised. The following information regarding the use of smart devices (watch, smartphone, tablet, laptop computer, etc.) in conjunction with a therapeutic continuous glucose monitor (CGM) will be incorporated into the Non-Medical Necessity Coverage and Payment Rules in an upcoming policy revision.
There is no Medicare benefit for supplies and accessories used with equipment that is not classified as DME. Coverage of a CGM system supply allowance (K0553) is available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. In addition, Medicare coverage is available for a CGM system supply allowance if a non-DME device (watch, smartphone, tablet, laptop computer, etc.) is used in conjunction with the durable CGM receiver (K0554). The following are examples of this provision:
- Medicare coverage of a CGM supply allowance is available where a beneficiary uses a durable CGM receiver to display their glucose data and also transmits that data to a caregiver through a smart phone or other non-DME receiver.
- Medicare coverage of a CGM system supply allowance is available where a beneficiary uses a durable CGM receiver on some days to review their glucose data but may also use a non-DME device on other days.
If a beneficiary never uses a DME receiver for a therapeutic CGM, the supply allowance is not covered by Medicare.
Smart devices are non-covered by Medicare because they do not meet the definition of DME (i.e., not primarily medical in nature and are useful in the absence of illness). Claims for smart devices must be billed using code A9270 (noncovered item or service).
Suppliers are encouraged to refer to the Glucose Monitors LCD and related Policy Articles for additional information on the coverage, coding and documentation requirements.
For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center or email the PDAC by completing the DME PDAC Contact Form. See the Contact Us webpage for details.
Date Posted 07/18/18