Reimbursement for Continuous Glucose Monitoring Devices (IB 22-23)

Date: 08/04/22

Louisiana Healthcare Connections would like to inform providers that effective August 1, 2022, the criteria will change for long‐term continuous glucose monitoring (CGM) devices through the durable medical equipment program.

Prior authorization is required and beneficiaries must meet one of the following eligibility criteria:

• Diagnosis of any type of diabetes with the use of insulin more than two times daily; or
• Evidence of level 2 or level 3 hypoglycemia; or
• Diagnosis of glycogen storage disease type 1a.

CGM devices require a prescription and documentation of medical necessity. In addition, beneficiaries who receive this coverage are required to attend regular follow-up visits with a healthcare provider at a minimum of every six months to assess the on-going benefits.

CGM sensor coverage will not change. The lifespan of a CGM sensor varies. The sensor may last 7, 10, or 14 days. The rate on file for CGM sensors incorporates these varying lifespans and represents a monthly rate rather than per unit rate.

Short-term CGMs will no longer be considered a covered device.

Louisiana Healthcare Connections will make system updates and recycle any claims that were paid incorrectly according to this change within 60 days of this notice. No action is needed by the provider, we will recycle any impacted claims within 15 days of their procedure file revisions.

Questions regarding fee-for-service claims should be directed to Gainwell Technologies Provider Relations at (800) 473‐2783 or (225) 924‐5040.