Billing FAQ
Find answers to some of the most common questions related to billing for Continuous Glucose Monitoring (CGM) systems. Understanding the billing process for CGMs can be confusing, and we want to provide you with the information you need to navigate it with confidence. Whether you're a patient, caregiver, or healthcare provider, this page will help you understand the various aspects of CGM billing, including insurance coverage, reimbursement, and out-of-pocket costs.
Does Performance Home Medical bill Medicare?
Performance Home Medical will bill under Durable Medical Equipment, not under Prescription plans. Plan B for Medicare. Insurance requirements vary. Your insurance may require additional documentation. For more information, please contact your insurance company.
Is Medicare coverage available for the Dexcom G6 System?
Medicare coverage is available for the Dexcom G6 system if the CGM reader/receiver is used to review glucose data on some days every month. Medicare coverage requirements must also be met.
Examples:
- Uses both the reader/receiver and a smartphone throughout the day.
OR - Uses the reader/receiver some days of the week and their smartphone other days of the week.
Is Medicare coverage available for the FreeStyle Libre 2?
Medicare coverage is available for the FreeStyle Libre 2 if the CGM reader/receiver is used to review glucose data on some days every month. Medicare coverage requirements must also be met.
Examples:
- Uses both the reader/receiver and a smartphone throughout the day.
OR - Uses the reader/receiver some days of the week and their smartphone other days of the week.
What are the prescription requirements to receive a CGM system?
- Patient name
- Date
- Description of the item or items
- Length of need
- Physician name or National Provider Identifier
- Physician's signature
Insurance requirements vary. Your insurance may require additional documentation. For more information, please contact your insurance company.
What documentation do I need to get from my physician so you can bill my insurance?
Documentation from an in-person visit with your physician that contains the following is required:
- Documents the patient has diabetes mellitus, and
- The patient is insulin-treated with three or more daily administrations of insulin or continuously uses an insulin pump, and
- The patients’ insulin treatment regimen requires frequent adjustment by the patient based on BGM or CGM testing.
Insurance requirements vary. Your insurance may require additional documentation. For more information, please contact your insurance company.
Who do I contact for more information about my insurance coverage?
Insurance requirements vary. Your insurance may require additional documentation. For more information, please contact your insurance company.