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How to get CGMS reimbursement

kevin's blog

My Child's Mother's View on Continuous

We just got the Dexcom Seven CGMS and it is terrific. The site did not hurt at all. Darby said it was a lot like getting a pump site and no worse (we use the inset by Animas which doesn't hurt much at all). The sensor is so tiny it looks like a half inch long filament of metal about the circumference of a piece of string. It was so tiny, we were able to put it in her arm instead of her hip and save valuable real estate for her pump sites. It calibrated easily and stayed pretty true to her numbers (within 20% compared to the meter).

CMS (Medicare) HCPCS Codes Are Out for CGMS Claims in 2008

According to a filing with the SEC by DexCom and reported by Edgar Online, CMS published the codes this past Friday for submitting cgms claims. There are codes for the sensor, the transmitter and the receiver. See details as filed in the original request for the codes: HCPCS 2008 Request Pending for creating reimbursement codes.

Here's the catch.

For some reason everybody thinks that if you have dedicated codes that it will improve reimbursement for the new technology.

Wrong.

And its name is 'Bob'

Don't ask me why but every medical device has to have a name. Darby has chosen Bob as the name for her Dex receiver and no rationale shared. Just Bob. I wonder if that's what they mean about device personalization? Probably not since it was so easy ;)

It's not always about the #

The other night Darby went low early in the evening after falling asleep. This is very unusual for her. Without the continuous monitor, she would have had a severe low (at least) ;(

Fortunately, after only being on it for about 4 days, the Dex gave us the alarm, we verified with the meter and treated a 66 (which the Dex said later turned into a 44). After that it was an easy night.

So, dropping the A1c will be great but it's already clear to me that there is so much more to cgms than lowering the A1c! Now to get the insurance companies to get it too.

2 Days & I've learned alot

So I decided to do a 'dry' run on me before starting up Darby who really has t1. I'll detail my experience in my next post as this is just quick notes. Went on campout w Darby for 2 days immediately following startup. I think I may be pre-diabetic?!!! Some very strange elevated glycemic episodes which were confirmed with spot checks following meals. Also went low overnight the first night... also confirmed. Hmmmm?

We're live

Warming up!Warming up my cgms

Got it

The Dex7 arrived. Reading, reading...

Reimbursement letter sent from Dex CDE, too. (attached) along with a cheat sheet of products that contain Acetaminophen.

What I wish I had was the best of the best of approved ltrs of medical necessity for BCBS of Texas! We'll get there as this resource grows.

Hopefully, we'll start up tomorrow or if not then Sunday.

Ordered CGMS

I got my letter of medical necessity signed on Friday and faxed into customer service along with the order form.

Monitoring YahooGroup on CGMS

Every once in a while you hear that so and so got approved for their CGMS. No details however...

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