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[IP] Re: (IP) Medicare coverage of CGMs



That's fantastic news and is an excellent result! One thing to know - there
are two types of coverage determinations resulting from appeals decisions
against a MAC (Medicare Administrative Contractor or "payment contractor") -
local coverage determinations and national. There are 13 MACs in the country
by region, so if it's a local determination it means it only applies within
that MAC and people in other regions whose Medicare is administered by a
different MAC are out of luck. However if it's a national coverage
determination then all MACs in the Country must follow it. I have not yet
looked at these links yet (but I intend to)B so I don't know if it specifies
whether it's a local or national determination. However it's good news in any
case and can definitely be cited by people appealing in other regions. Love
the judge'sB name :)Pam
<Here is some very good news. An administrative law judge (ALJ) from the
Medicare Departmental Appeals Board, Civil Remedies Division, has essentially
thrown out the CMS argument that CGM equipment is non covered because it is
PRECAUTIONARY! The case was brought against NHIC, a Medicare DME
administrative
contractor, and the Center for Medicare Services (CMS) that used Policy
Article
A33614 to deny CGM coverage. Judge Keith W. Sickendick, his real name, has
issued a preliminary decision which will become final when CMS fails to
provide
medical documentation for the ridiculous NHIC policy article issued more than
ten years ago.

 Dr. Nick Argento, an endocrinologist from Maryland, has supported several of
his Medicare patients in their efforts to obtain CGM coverage. If anybody
wants
to try you may use this case when your claim is denied by Medicare and/or
your
private health insurance plan. Here is the link to Dr. Nick's website which
includes several other important links.>
.
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