Medicare-CGM Appeals Process and Resources

Medicare does not now cover personal use of CGM, but many patients have been appealing the non coverage decision, and some have won coverage. To find out more about this topic, follow this link, an article written for the type 1 diabetes online site Glu (myglu.org) by Dr Argento: https://myglu.org/articles/getting-medicare-to-cover-cgms-what-you-can-do

In addition, there has been an important development about Medicare non coverage of CGM. There was a successful legal challenge to the technical basis of non coverage. While Medicare has appealed this decision for a third time and the final outcome is pending, it is now public information, and the two prior judges’ rulings can be used to support coverage for other Medicare beneficiaries. More information about this is available from the website of Debra Parrish, esq, the lawyer who has so far won the case for the Medicare patient:
http://dparrishlaw.com/judge-strikes-medicare-policy-that-denied-cgm-as-precautionary/

The general link for the ‘news’ section of her website, where the updates on this case are discussed, is: http://dparrishlaw.com/news/

Legal Decision and Interpretation, from http://dparrishlaw.com/news/

In addition, we have resources available that patients can use to support their appeal of Medicare non coverage of CGM. These can be downloaded and sent with your own personal letter, and a letter from your doctor. They are letters and documents that support the medical necessity of CGM use:

In addition, a letter on how to appeal from a patient who was successful at getting Medicare to cover CGM is here:

We at Maryland Endocrine believe that non coverage of CGM by Medicare is dangerous, unfair, and medically indefensible. We are willing to support the efforts of our patients to fight back! Don’t give up- you can win.

Additional Resources

Alert Notice

Holiday Schedule

December 15, 2017 the office will be closed at 12 noon for the annual holiday party.
December 25, 2017 the office will be closed for the Christmas holiday
January 1, 2018 the office will be closed for New Years day holiday.
Emergencies only you can reach the on call physician as 800-454-3598 otherwise call the office on the next business day.