What's Wrong with This Picture? A Critical Review of Current Centers for Medicare & Medicaid Services Coverage Criteria for Continuous Glucose Monitoring

• Type of Material: Article
• Authors: Rodolfo Galindo, Emory University; Christopher G Parkin, CGParkin Communications, Inc; Grazia Aleppo, Northwestern University; Anders L Carlson, International Diabetes Center, Minneapolis; Davida F Kruger, Henry Ford Health System; Carol J Levy, Icahn School of Medicine at Mount Sinai; Guillermo Umpierrez, Emory University; Janet B McGill, vWashington University in St. Louis
• Language: English
• Date: 2021-04-27
• Publisher: MARY ANN LIEBERT, INC
• Publication Version: Final Published Version
• Copyright Statement: © Rodolfo J. Galindo, et al., 2021; Published by Mary Ann Liebert, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1089/dia.2021.0107
• Title of Journal or Parent Work: DIABETES TECHNOLOGY & THERAPEUTICS
• Volume: 23
• Issue: 9
• Start Page: 652
• End Page: 660
• Grant/Funding Information: Dexcom, Inc., provided funding for editorial assistance in developing this article.
• Keywords: Continuous glucose monitoring; OPEN-LABEL; Centers for Medicare & Medicaid Services; MULTICENTER; Insurance coverage; Type 1 diabetes; ADULTS; SEVERE HYPOGLYCEMIA; GLYCEMIC CONTROL; QUALITY-OF-LIFE; DAILY INSULIN INJECTIONS; IMPACT; Science & Technology; Endocrinology & Metabolism; SENSING TECHNOLOGY; TYPE-1; Life Sciences & Biomedicine; Type 2 diabetes
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Numerous studies have demonstrated the clinical value of continuous glucose monitoring (CGM) in type 1 diabetes and type 2 diabetes populations. However, the eligibility criteria for CGM coverage required by the Centers for Medicare and Medicaid Services (CMS) ignore conclusive evidence that supports CGM use in various diabetes populations that are currently deemed ineligible. This article discusses the limitations and inconsistencies of the CMS eligibility criteria relative to current scientific evidence and proposes workable solutions to address this issue and improve the safety and care of all individuals with diabetes.