Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

Implantable glucose monitor requests are becoming more frequent from those who have diabetes mellitus. Continue reading below to find out more about the recently updated guidance from Centers for Medicare & Medicaid. nnAs requests for implantable glucose monitors continues to rise among diabetes mellitus (DM) patients, continued guidance from Centers for Medicare & Medicaid Services (CMS) continues.nEffective October 11, 2020, CMS released the newest round of guidance with article A58110 and Local Coverage Determination (LCD) L38617.nThese documentations revealed indications for coverage, limitations, and exceptions.nTherapeutic I-CGMs are considered medically reasonable and necessary by Medicare when all of the following coverage criteria (1-5) are met:n

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1. The beneficiary has diabetes mellitus (Refer to the related Billing and Coding Article [A58110] for applicable diagnoses); and,

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2. The beneficiary is insulin-treated with multiple (three or more) daily administrations of insulin or a Medicare-covered continuous subcutaneous insulin infusion (CSII) pump; and,

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3. The beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of blood glucose monitor (BGM) or CGM testing results; and,

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4. Within six (6) months prior to ordering the I-CGM, the treating practitioner has an in-person visit with the beneficiary to evaluate their diabetes control and determined that criteria (1-3) above are met; and,

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5. Routine recommended follow-up care is expected.

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nOriginal article published on cms.gov