Suppliers Documentation for Claims for Refills of Essential

5.10.2 - Suppliers Documentation for Claims for Refills of Essential Accessories for Beneficiary-Owned Continuous Positive Airway Pressure (CPAP), Respiratory Assist Devices (RADs), and Continuous Glucose Monitors (CGMs) (Rev. 13356; Issued: 08-14-25; Effective: 01-01-24; Implementation: 09-16-25) When reviewing claims for refills of essential accessories for beneficiary-owned CPAP, RADs, and CGMs, the contractor shall review for continued medical necessity of the DME and necessity of the refill accessory. Contractors are not required to determine that the requirements for provision of the CPAP, RAD, and CGM as when it was originally ordered were met. For example, even though a face-to-face encounter is required for the initial provision of the CPAP device, it is not needed for refill of a CPAP mask for a patient-owned CPAP device covered by Medicare in the past. However, documentation from the treating practitioner that indicates the CPAP or RAD which requires refill accessories/supplies continues to be medically necessary is required. Timely documentation is defined as a record in the preceding 12 months unless otherwise specified elsewhere in the policy. Likewise, for CGM supplies, contractors would not need to see the initial qualifying documentation but will need to verify that medical need for continuing coverage, as prescribed in applicable policy (e.g., Local Coverage Determination) is met. These instructions do not replace or alter other longstanding instructions related to coverage and payment for reasonable and necessary accessories for patient-owned DME. Contractors shall continue to adhere to these program policies and procedures.