63 lines
1.9 KiB
JSON
63 lines
1.9 KiB
JSON
{
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"_comment": "Wear-day rules by device type and payer. Used by coverage_calculator.py. Update when payer LCD policies change.",
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"devices": {
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"dexcom_g6": {
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"display_name": "Dexcom G6",
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"sensor_wear_days": 10,
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"transmitter_wear_days": 90,
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"components": ["sensor", "transmitter"]
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},
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"dexcom_g7": {
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"display_name": "Dexcom G7",
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"sensor_wear_days": 10,
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"components": ["sensor"]
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},
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"freestyle_libre_2": {
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"display_name": "FreeStyle Libre 2",
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"sensor_wear_days": 14,
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"components": ["sensor"]
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},
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"freestyle_libre_3": {
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"display_name": "FreeStyle Libre 3",
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"sensor_wear_days": 14,
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"components": ["sensor"]
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},
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"omnipod_5": {
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"display_name": "Omnipod 5",
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"pod_wear_days": 3,
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"sensor_wear_days": 14,
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"components": ["pod", "sensor"],
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"_note": "Sensor wear days apply to the paired CGM (typically Dexcom G6 or Libre). Pod is 3 days. Track components separately."
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}
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},
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"payer_rules": {
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"medicare": {
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"visit_renewal_days": 180,
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"refill_window_days": 30,
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"_note": "Medicare requires face-to-face physician visit every 6 months for continued CGM coverage. Refill window opens 30 days before coverage end.",
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"covered_devices": [
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"dexcom_g6",
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"dexcom_g7",
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"freestyle_libre_2",
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"freestyle_libre_3"
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]
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},
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"medicaid": {
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"visit_renewal_days": null,
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"refill_window_days": 30,
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"_note": "Medicaid rules vary by state. Renewal cadence not enforced at this layer — flag for manual review.",
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"covered_devices": []
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},
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"commercial": {
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"visit_renewal_days": null,
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"refill_window_days": 30,
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"_note": "Commercial payer rules vary by plan. Refill window is a conservative default.",
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"covered_devices": []
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},
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"default": {
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"visit_renewal_days": null,
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"refill_window_days": 30,
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"covered_devices": []
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}
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}
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}
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