The Centers for Medicare & Medicaid Services (CMS) recently released a final rule that will go into effect on February 28, 2022, classifying non-implantable continuous glucose meters (CMGs) as long-lived medical devices (EMRs), regardless of whether CGM has been approved or approved by the Food and Drug Administration (FDA) to replace a glucometer for use in diabetes treatment decisions. CMGs that do not replace a glucometer are called auxiliary CMGs because they can be used in addition to the glucometer by reporting trends in blood glucose levels and informing the patient of potentially dangerous levels even while sleeping, which must then be checked with a separate glucometer. The final rule can be downloaded at: www.federalregister.gov/documents/2021/12/28/2021-27763/medicare-program-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos-policy-issues CGS: www.cgsmedicare.com/jc/coverage/lcdinfo.html (then click on Future LCD – Future Effective Date) Noridian: med.noridianmedicare.com/web/jadme/policies/lcd/future;jsessionid=17CEBA5C02D109306989C28E710 E87C3 December 21, 2021 The Centers for Medicare & Medicaid Services (CMS) has published a final rule that establishes procedures for determining benefit categories and payment terms for new DMEPOS items and services under Medicare Part B. The final rule can be downloaded from CMS.gov at www.cms.gov/medicare/durable-medical-equipment-prostheticsorthotics-and-supplies-fee-schedule/dmepos-federal-regulations-and-notices. Link to the YES and JD reopening request form: protect2.fireeye.com/url?k=9c38cccc-c06dc51c-9c38fdf3-0cc47a6a52de-a333b2b0726c3520&u=med.noridianmedicare.com/documents/2230703/6501021/Reopening+Request Link to the reopening request form JB: protect2.fireeye.com/url?k=81ac222f-ddf92bff-81ac1310-0cc47a6a52de-4bcb538bf030571d&u=www.cgsmedicare.com/jb/forms/pdf/jb_reopenings_form.pdf Some examples of EMRs are the walking aids, hospital beds, household oxygen devices, diabetes self-testing devices (and accessories), and some nebulizers and their medications (no disposable items). Wheelchairs and scooters are also included in the EMR list, but additional rules apply. (See below.) To find out if Medicare covers the equipment or accessories you need, or to find an EMR provider in your area, call 1-800-MEDICARE or visit www.medicare.gov. You can also learn more about DME`s Medicare coverage by contacting your state health insurance assistance program (SHIP). Medicare Part B (health insurance) covers durable medical equipment (EMR) (www.medicare.gov) for as long as it is medically necessary and for use in your home. Only your doctor can prescribe durable medical devices.
If you live in an area that has been declared a disaster or emergency, the usual rules for your medical care may change for a short time. Learn more about how to replace lost or damaged equipment in the event of a disaster or emergency. While the following list is not exhaustive and other items may be covered, here are some examples of common long-term medical devices that are often covered by Medicare Part B. This applies to both durable medical devices and other benefits covered by the plan. The main difference between Original Medicare and Medicare Advantage is how you cover a durable medical device. For example, a Medicare Advantage plan may require pre-approval for items to be covered. You may also need to use a Doctor and a Medicare-approved provider who is part of the plan network. CMS expects that the Medicare Claims Processing Manual will be updated to reflect the gap filling method described above. Medicare defines long-lived medical devices, or EMRs, as reusable medical devices that have been deemed medically necessary. Your doctor or other health care provider will determine the equipment you need according to Medicare guidelines.
It assesses your health, the equipment that can be used in your home and the equipment you can use. From now on, for claims with a delivery date of February 28, 2022 to March 31, 2022, suppliers must use HCPCS code E1399 (Durable Medical Devices, Miscellaneous) to file claims for CGM ancillary beneficiaries and HCPCS code A9999 (Miscellaneous EMR Delivery or Accessories, not otherwise specified) to file claims for additional monthly deliveries of CGM. Effective for claims with delivery dates from 1. April, in 2022, suppliers are expected to use the new HCPCS codes E2102 (continuous glucose monitor or adjuvant receptor) to submit applications for additional CGM recipients and the HCPCS code A4238 (supply allocation for non-implantable continuous supplementary glucose meters (CMGs), including all consumables and accessories, 1 month supply = 1 service unit) to submit requests for monthly CGM deliveries Additional. This policy does NOT apply to the replacement of accessories for a CPAP or RAD device that has been in continuous use for less than 13 months, or to the replacement of accessories for a CPAP or RAD device owned by the recipient but not purchased from Medicare.