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OIG to review CGM payments

OIG to review CGM payments

WASHINGTON – The Office of Inspector General has added to its work plan a review of Medicare payments for continuous glucose monitors and sensors and how they compare to prices available to consumers. The agency will compare Medicare payments to supplier acquisition costs and prices otherwise available to consumers for selected CGMs and their sensors to determine if there are potential cost savings for Medicare and enrollees. In 2022, Medicare Part B allowed more than $1.1 billion in payments for CGMs and sensors. If the OIG finds that Medicare payments for CGMs greatly exceed their acquisition costs, then CMS has the authority to adjust payment rates for CGMs and sensors through two methods: It can adjust the fee schedule prices using its inherent reasonableness authority, or it can introduce an item into the competitive bidding program.

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