(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . Confusing Medicare Coverage for Diabetic CGMs [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.'] Date: 2023-10-18 Yes, both FreeStyle Libre and Dexcom CGMS are covered, but Medicare’s account of the process is extremely unclear. I don’t think that it’s a real problem, but as a former tech writer I am appalled by this bafflegab. My mantra in those days was Clear, correct, and complete Yes, CGMs are good for diabetic cats, too, but Medicare isn’t pootie-friendly Medicare Medicare.gov: Continuous glucose monitors If your doctor determines that you meet all the coverage requirements, Medicare covers continuous glucose monitors and related supplies for making diabetes treatment decisions (like changes in diet and insulin dosage). The requirements include the need to: Frequently check your blood sugar (4 or more times a day), and Either use an insulin pump or get 3 or more insulin injections per day. You must also make routine in-person visits with your doctor. I have been on Ozempic and glipizide, I rarely take insulin now, but I have had a number of high or low glucose warnings from my CGM. Do I qualify? Center for Medicare Services: Glucose Monitors Issue Description The proposed LCD [Local Coverage Determination] modifies the coverage criteria for Continuous Glucose Monitors (CGMs) based on the best available evidence. To be eligible for coverage of home blood glucose monitors and related accessories and supplies, the beneficiary must meet both of the following basic criteria (1)-(2): The beneficiary has diabetes (Refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses); and, The beneficiary’s treating practitioner has concluded that the beneficiary (or the beneficiary’s caregiver) has sufficient training using the particular device prescribed as evidenced by providing a prescription for the appropriate supplies and frequency of blood glucose testing. That’s a conventional glucose monitor requiring finger sticks and test strips. To be eligible for coverage of a CGM and related supplies, the beneficiary must meet all of the following initial coverage criteria (1)-(5): The beneficiary has diabetes mellitus (Refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses); and, The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the CGM prescribed as evidenced by providing a prescription; and, The CGM is prescribed in accordance with its FDA indications for use; and, The beneficiary for whom a CGM is being prescribed, to improve glycemic control, meets at least one of the criteria below: The beneficiary is insulin-treated; or, The beneficiary has a history of problematic hypoglycemia with documentation of at least one of the following (see the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS section of the LCD-related Policy Article (A52464)): Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or, A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia Within six (6) months prior to ordering the CGM, the treating practitioner has an in-person or Medicare-approved telehealth visit with the beneficiary to evaluate their diabetes control and determined that criteria (1)-(4) above are met. Recurrent, persistent hypoglycemia? What’s that? When I go below 54 mg/dL I eat glucose tablets or carbs, and a few minutes later my blood glucose goes up. Well, OK, I get warnings about that several times a week, so I guess that’s what they want to hear about. I fainted from low blood glucose once, but that was decades ago. CGM Continued Coverage Every six (6) months following the initial prescription of the CGM, the treating practitioner conducts an in-person or Medicare-approved telehealth visit with the beneficiary to document adherence to their CGM regimen and diabetes treatment plan. When a CGM (code E2102 or E2103) is covered, the related supply allowance (code A4238 or A4239) is also covered. Supplies (code A4238) for an adjunctive CGM integrated into an external insulin infusion pump are covered when the beneficiary meets both the CGM coverage criteria and the coverage criteria for an external insulin infusion pump. Refer to the External Infusion Pumps LCD (L33794) for additional information regarding billing a CGM receiver incorporated into an insulin infusion pump. Abbott: The FreeStyle Libre systems are now widely covered by Medicare*1 The FreeStyle Libre 2 and FreeStyle Libre 3 systems are covered by Medicare for people managing diabetes with insulin*1. If you take insulin for your diabetes, ask your healthcare provider about the FreeStyle Libre 2 or FreeStyle Libre 3 system. Dexcom Is Dexcom covered by Medicare? Yes. The Dexcom G6 and Dexcom G7 are covered by Medicare if you meet their criteria. Dexcom now ships Dexcom G6 and Dexcom G7 to Medicare patients with traditional fee-for-service coverage. You can get Medicare coverage for therapeutic CGM if you: Have type 1 or type 2 diabetes, Use insulin (any kind) Don’t use insulin but have had certain low blood sugar events Medicare recently updated its coverage requirements for CGM. For a full description of coverage criteria, Click HERE [link to CMS] . Wait, is that what Medicare said? But my insurance doesn’t cover my FreeStyle Libre 3s. My pharmacy can get me a better discount. I’m going to have to talk with some people. Me I’m sorry I didn’t get to do that other research before writing this. I had a bad cold yesterday that prevented my from writing or even standing up unassisted. So I went to bed, and used a tray table to access my laptop to watch the House Speaker vote. I’m feeling much better now, with throat lozenges and decongestants and lots of fluids. Fortunately, I had written most of this story before that attack. Also, it’s time for me to change my Medicare Part D insurance. Maybe. If I can get a better price on Ozempic. Medicare and Ozempic will be a story for another day, actually a recurring story. My blood sugar has been significantly down for the last two weeks, to the point where I had to go off all of my diabetes meds. My GMI has been 5.9. Getting the tray table turns out, as expected, to be a wonderful idea. It relieves the pressure on my legs from my previous lap board. That is helping a lot with my mild neuropathy, which has retreated from my feet to just my toes. Exercise also helps to increase blood flow. And how are you? [END] --- [1] Url: https://www.dailykos.com/stories/2023/10/18/2198687/-Confusing-Medicare-Coverage-for-Diabetic-CGMs?pm_campaign=front_page&pm_source=more_community&pm_medium=web Published and (C) by Daily Kos Content appears here under this condition or license: Site content may be used for any purpose without permission unless otherwise specified. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/dailykos/