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The FUTURE Local Coverage Article: Glucose Monitor - Policy Article (A52464) and FUTURE Local Coverage Determination (LCD): Glucose Monitors (L33822) are now available for viewing on the CMS website. While most of the edits are minor changes to verbiage, there are two changes that relate to coverage criterion, effective for dates of services on or after July 18, 2021.

Notable changes to the LCD include  (1) The removal of the four times a day testing requirements, and (2) Changing the term to “administration” from “injection” which accounts for inhaled insulin.  

Additionally, changes to the Policy Article were mostly minor changes in sentence structure or verbiage, however, the major change in the future effective policy article will be to the coding information section in which all glucose monitor codes will be listed. 

Remember, these changes are not effective until July 18, 2021. Any items provided and billed prior to July 18, 2021 will require the current LCD and PA coverage criterion to be met. 

Want to make sure your CGM claims are meeting coverage requirements? Let the experts at vHG help! 

Our team can prescreen your claims to ensure coverage criteria is met, conduct monthly, quarterly or one-time proactive claims audits, or provide consultation on an as-needed basis.

Contact us today to learn more today!