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We have positive news to share for people with diabetes who are on insulin and would like to use a CGM (Continuous Glucose Monitor)!

The Center for Medicare and Medicaid Services (CMS) is relaxing some of their stringent requirements for obtaining a CGM during the COVID-19 pandemic.

“CMS will not enforce certain clinical criteria in local coverage determinations that limit access to therapeutic continuous glucose monitors for beneficiaries with diabetes. As a result, clinicians will have greater flexibility to allow more of their diabetic patients to monitor their glucose and adjust insulin doses at home.”

CMS just announced they would not enforce certain clinical criteria for obtaining a CGM, insulin pump, or associated supplies during the pandemic. For example, in-clinic provider visits, certain lab tests like a C-peptide or antibody testing, and demonstrations of SMBG would not be mandatory.

This is huge for people with diabetes!

It would limit visits to hospitals, clinics, and labs and help reduce exposure to the coronavirus at these public facilities.

Since CGM’s and insulin pumps have the ability to transmit the collected data to a provider for a telehealth consult, providers can now use that data to review during telehealth visits. This can strengthen the relationship during COVID by allowing for data-driven insulin adjustments.

This is a win-win situation and we can hope that private insurance companies will follow the lead of CMS for the benefit of people with diabetes who use insulin.

To learn more read diaTribe’s article and visit CMS.gov.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

As Diabetes Specialists, we want to ensure the safety of patients and colleagues, while providing diabetes care to those who may be the most vulnerable and isolated during this pandemic.

According to the CARES Act, Diabetes Self-Management Training (DSMT) can be provided to patients via telehealth during the pandemic. Though the original regulations had many gaps.

Previously, the CARES Act required that telehealth visits must include both audio and video, while many hospital outpatient clinics were running into billing barriers. In addition, under the original guidelines, RNs and Pharmacists were not included in the approved list of telehealth DSMT Providers.

See: ADCES Summary Sheet of DSMT and Telehealth FAQ for more information.

Though as of April 23, 2020 the guidelines have been updated.

Good News – these updates to the CARES Act now expand blanket waivers under the 1135 waiver.

For any of the information below, please check with your compliance team for clarification and share the important resource links below with your billing department.

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How do CMS Updates Affect Our Ability to Provide DSMT Training?

DSMT Can Now be Audio-Only

DSMT services may be billed for audio-only, but only if the video is not available or possible. Make sure to document the mode of instruction and the rationale if using audio-only. 

See: COVID-19 Emergency Declaration Waiver for more information.

Can RNs & Pharmacists Now Provide Telehealth and Bill for DSMT?

The ADA and ADCES have been working hard to decipher the language and intent in the updated guidelines. It seems that RN and Pharmacists are now included based on an assessment of the wording in the new documents. CMS continues to expand the definition of providers eligible to furnish telehealth services during the COVID-19 public health emergency.

As DSMT programs bill as an entity, rather than at the individual provider level, the American Diabetes Association is seeking confirmation that DSMT programs that are eligible through Medicare Part B, are considered distant site practitioners approved to furnish telehealth services.

See: Blanket Waivers for HealthCare Providers Fact Sheet for more information.

Hospital-Based Programs Can Bill for Telehealth DSMT on the UB-04 (Medicare Claims) Form

Hospitals may now bill for education and management services (i.e. DSMT) as if they were furnished in the hospital and consistent with any specific requirements for billing Medicare in general, including any relevant modifications in effect during the COVID-19 PHE.

In summary:

• DSMT services can be provided in the hospital outpatient setting remotely to a patient in their home.
• The patient’s home can serve as a temporary provider-based department of the hospital (CMS’ Hospitals Without Walls initiative).
• If you previously billed using the UB-04, continue to bill the same way.
• The patient must be a registered outpatient of a hospital.
• DSMT and scope of practice requirements must be met.

See: CMS Hospitals Without Walls Initiative for more information.

Important to note: Please consult with your organization’s billing department and compliance team if you have questions.

Sources and Links

• CMS Press Release Summarizing April 30 Guidance.
• Hospitals CMS Flexibilities to Fight COVID Fact Sheet.
• Blanket Waivers for HealthCare Providers Fact Sheet
• Telehealth Information: List of billing codes are available here.

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.