CMS to Allow for 90-Day Billing for CGM Supplies

WASHINGTON— In what was called a “big win” by the American Association for Homecare (AAHomecare) the Centers for Medicare & Medicaid Services (CMS) published a change request (CR) directing DME MACs to adjust their local edits to allow for 90-day billing for continuous glucose monitor (CGM) supplies to align with blood glucose monitor supplies.

The effective date of this change is Jan. 1, 2024. The CR notes the change will be implemented by the Fraud Prevention System and UPIC. CMS said it will provide educational content to suppliers in an MLN Connects newsletter. 

“The 30-day billing requirement for CGM supplies was a source of confusion for patients and an unnecessary paperwork burden on suppliers and DME MACs,” said Tom Ryan, AAHomecare president and CEO. “I appreciate the persistent work of our Diabetes Council and Regulatory Council in making the case for this common-sense change with regulators. This is a big win for CGM suppliers and their patients.”

According to AAHomecare, its Regulatory Council has been working on this issue for the past two years, and the Diabetes Council has made CGM billing a priority since its inception last year. One example of this work is AAHomecare’s comments to CMS on a proposed LCD on CGMs in November 2022 (see page 6).

“The change will reduce burden for suppliers and patients who are currently billing every 30 days for CGM supplies shipped every 90 days,” said a statement released by AAHomecare. “AAHomecare thanks CMS for reviewing the industry’s request and making the change.”