Medicare Establishes National Payment Rate for Eversense® CGM System
November 12, 2019 at 04:03 pm
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Senseonics Holdings, Inc. announced that the Centers for Medicare and Medicaid Services (CMS) finalized a national payment rate for Eversense that was recently published in the calendar year 2020 Physician Fee Schedule Final Rule. The Eversense CGM system will be the first CGM technology to be reimbursed through the Part B Medical Services benefit for Medicare beneficiaries and expands access to the latest innovation in continuous glucose monitoring. This recent update to the physician fee schedule will allow for health care providers (HCPs) to insert Eversense immediately in their clinic once a patient and HCP agree that Eversense CGM is the right choice for them. After the insertion of Eversense, HCPs may bill Medicare directly with the existing CPT codes that will include the cost of the Eversense CGM system and the procedure time. This approach fundamentally changes how patients access CGM in that the HCP will be able to offer the technology directly in their office as opposed to a patient having their CGM system processed through their durable medical equipment benefit. This step forward will improve both the patient and HCP experience by reducing the amount of paperwork needed to secure CGM and it affords improved coordination of care for patients managing diabetes by removing procurement barriers.
Senseonics Holdings, Inc. is a medical technology company focused on the development and manufacturing of glucose monitoring products designed to transform lives in the diabetes community. Its glucose monitoring (CGM) systems, Eversense, Eversense XL, and Eversense E3 include a small sensor inserted completely under the skin that communicates with a smart transmitter worn over the sensor. The glucose data are automatically sent every five minutes to a mobile app on the user's smartphone. Eversense consists of three primary components: a small sensor inserted subcutaneously under the skin by a healthcare provider; an external removable smart transmitter that receives, assesses and relays data from the sensor and provides vibratory alerts; and a mobile app that receives data from the transmitter and provides real-time glucose readings, alerts and other data the person's mobile device. Its CGM system continually and accurately measures a person's glucose levels for up to six months.