Which Cgm Devices Are Covered By Medicare
The Dexcom G5 was one of the first of the CGM devices to be FDA approved as a therapeutic CGM in 2017, which qualified the device for Medicare coverage. As with most other technology, diabetes technology continues to evolve, and newer products have since followed suit, including those manufactured by Abbott, Medtronic, and others.
Currently, Aeroflow offers the Dexcom G6, the FreeStyle Libre 14 Day System and the FreeStyle Libre 2, all eligible for Medicare coverage. The Dexcom devices are typically worn on the skin of the torso for up to 10 days, where a water resistant sensor can measure and transmit blood glucose readings every few minutes to a reader or a smartphone app. The FreeStyle Libre is a line of continuous glucose monitors that are typically worn on the skin of the upper arm for up to 14 days. Unlike the Dexcom, the FreeStyle is a flash glucose monitoring system, meaning that while it continually measures blood glucose levels, it only transmits this to a reader when scanned. Each has its own set of unique features, alarms, and recommended age range.
Medicare Part B Covered Diabetes Testing Supplies
Part B covers a number of blood sugar self-testing supplies and equipment, even if you dont use insulin. These include:
- Blood sugar monitors
- Lancet devices and lancets
- Glucose control solutions
These supplies are considered durable medical equipment, and the actual amount of supplies that are covered varies depending on whether or not you use insulin. For example, if you use insulin, you may be able to get up to 300 test strips and 300 lancets every three months, but if you dont use insulin you may only be able to get up to 100.
If your doctor says its medically necessary, Medicare will cover additional test strips and lancets.
Test strips can be used to help monitor certain substances in the blood. They are small, single-use pieces of paper-like substance that you place one or two drops of blood on, and insert into a testing device. These devices provide results within seconds, and you can address any concerns regarding blood glucose levels.
Does Medicare Pay For Cgm Accessories And Supplies
Yes, Medicare generally pays 80% of the cost of CGM accessories and supplies. Under the guidelines, Medicare Part B covers:
- Patch refills based on the recommended replacement schedule. For example, if you use a CGM that requires a new patch every 14 days, Medicare will pay for two patches every 28 days.
- Up to 300 test strips every three months if you are being treated with insulin
- Up to 300 lancets every three months if you are being treated with insulin
Medicare Part D may also cover:
- Alcohol swabs
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Blood Glucose Meter & Insurance Coverage
Different plans cover varying amounts of the meter/ strips there are exceptions to the list below. Many plans cover strips through prescription plans so be sure to verify prescription plan coverage. Sometime itâs more cost effective through DME so individual should check his/ her coverage. Also, some meter companies offer discount cards so it may be more cost effective to use the copay card instead of the recommendations below. Abbott/Freestyle is now available with automatic lower copays for all commercial plans at participating pharmacies . Recommended meters by each company: Abbott – Freestyle Freedom, Freestyle Lite, Freestyle Insulinx, or Precision x-tra Accu-chek – Guide, Nano, Aviva or Compact Plus Bayer – Contour, Contour Next, Contour USB, or Breeze 2 One Touch – Verio, Ultra, Ultra 2, Ultra Smart, Ultra MiniContinue reading > >
What Diabetes Supplies Does Insurance Cover
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What Should Providers Do When Contacted By Cms Regarding Their Cgm Device Billing History
With CMS, the HHS OIG, and the DOJ all prioritizing enforcement with regard to Medicare billing for CGM devices, entities that bill Medicare for CGMs need to be prepared for the possibility of an audit or investigation. If contacted by auditors or federal agents, providers, pharmacies, and others should be prepared to:
Identify Relevant Documentation and Initiate an Internal Compliance Audit
Immediately upon learning of an audit or investigation, it is imperative to identify and preserve all relevant documentation. This includes Medicare compliance policies and procedures, patient records, and billing records pertaining to DME and non-DME continuous glucose monitoring devices. An internal compliance audit needs to be conducted at this time as well, as it will be necessary to determine whether auditors or investigators are going to uncover Medicare billing violations.
Establish Clear Lines of Communication and a Chain of Command
All internal personnel should be instructed not to communicate with auditors or agents directly. There should be a clear chain of command, and all communications with federal authorities should be routed through the practices or companys defense counsel.
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How Do I Get Medicare To Cover A Cgm
For Medicare to cover the cost of FreeStyle Libre, you must:
- Continue to pay your Part B premium
- Have already paid your Part B deductible
- Receive a prescription for the device from a physician who accepts Medicare
- Buy the CGM from a supplier who accepts Medicare
- Cover whatever portion of the costs that Medicare doesnt
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Medicare Coverage Of Cgm
Medicare has provided coverage for CGM systems since 2017, provided they are classified as therapeutic devices, meaning users can use them to make treatment decisions. These include things like changes to exercise regimen, diet or insulin dosage. While thats still the case, The Centers for Medicare & Medicaid Services have recently relaxed Medicares other coverage criteria somewhat. Previously Medicare coverage of CGM devices was limited to patients who met the following requirements:
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Have a diagnosis of either type 1 or type 2 diabetes
-
Use a traditional blood glucose meter and test blood sugar levels four or more times a day
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Are treated with insulin injections or insulin pump
- Require frequent adjustments to their insulin regimen
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Have an in-person visit with a doctor to evaluate glycemic control and whether they meet the above criteria, as well as follow up appointments every 6 months after prescription
So whats changed? No longer are insulin injections the only acceptable form of insulin administration for those who are covered. Now, diabetics who are treated with inhaled insulin will be eligible for coverage. Additionally, the requirement for self-testing up to four or more times a day with a fingerstick test has been removed, so diabetics who test less frequently may also be eligible.
Diabetes Supplies And Services Covered By Medicare Part B
- Blood glucose testing supplies and equipment
- Insulin pumps and insulin used with a pump
- Diabetes self-management training
- Medical nutrition therapy, including diet and lifestyle counseling
- Hemoglobin A1C tests to monitor blood glucose control
- Foot exams and treatment for diabetes-related nerve damage
- Therapeutic shoes or inserts
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Does Medicare Cover Continuous Glucose Monitors For Diabetes
- Does Medicare cover continuous glucose monitors? Learn who’s eligible for monitors through Medicare, what additional supplies are covered and other ways to get a monitor.
In 2018, an estimated 13% of U.S. adults had diabetes. Among people aged 65 and over, that number rose to 26.8%. As older adults make up the bulk of the 63.3 million people enrolled in Medicare, its no surprise that the government is looking for better ways to help beneficiaries manage the condition.
Continuous glucose monitors use sensors under your skin to monitor blood glucose levels 24 hours a day. This information is sent to a wearable device or smartphone, giving users the ability to easily track blood sugar levels and determine dosing needs. These devices have resulted in better glycemic control, so theyre increasingly being recommended to people with diabetes. Find out if and how Medicare covers continuous glucose monitors.
Lifescan Onetouch Products Only Covered Products Starting January 2016
Home > What’s New > News > Important Updates > Latest News > 2015 News > LifeScan OneTouch products only covered products starting January 2016 LifeScan OneTouch products only covered products starting January 2016 At Independent Health we are committed to improving the care of diabetic patients and providing physicians with important information that supports efforts to provide appropriate, safe and cost-effective therapy. Following a comprehensive review of the available blood glucose monitoring systems, test strips and supplies, Independent Health and its Pharmacy and Therapeutics Committee have determined that LifeScans OneTouch blood glucose meters and its test strips will be the preferred diabetic testing products for Independent Health commercial and Medicare members, effective January 1, 2016. Members currently using other brands of blood glucose meters will be able to order a OneTouch Blood Glucose Meter at no charge. All other brands of test strips will require prior authorization. Independent Health will cover only these meters as of 1/1/16 Independent Health will cover only these test strips as of 1/1/16Continue reading > >
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Does Medicare Cover Diabetes Shoes
Medicare pays for therapeutic shoes and inserts when necessary. Patients often need shoes because diabetes takes a toll on the feet and circulation. Medicare pays for the shoes when a qualifying doctor prescribes diabetic shoes.
However, compression stockings dont receive Medicare coverage.
Medicare pays for one of the following each year:
- One pair of depth-inlay shoes + 3 pairs of shoe inserts
- One pair of custom-molded shoe
- patients that are unable to wear the custom shoes because of a foot deformity may substitute for two extra shoe inserts
Some instances allow Medicare to cover separate shoe adjustments instead. When your treating doctor certifies that you meet the three following conditions, Medicare will pay for your therapeutic shoes.
You must have one of the following in one foot or both:
- Partial or complete foot amputation
- History of foot ulcers
- Deformity of the foot
$0 Copays On Preferred Brand Diabetic Test Strips And Glucose Meters For Medicare Advantage Members
In 2018, Independence will continue the requirement for Medicare Advantage members to use diabetic test strips and a glucose meter from the preferred manufacturer brands, Accu-Chek® and OneTouch®, in order to have their test strips and glucose meters covered at $0 copayment. All other manufacturersâ brand of test strips and glucose meters will not be covered by Keystone 65 HMO plans. For Personal Choice 65SM PPO plans, an out-of-network coinsurance will apply to all other manufacturersâ brand of test strips and glucose meters. If their current glucose meter does not work with either of the preferred brands of test strips, Medicare Advantage members can obtain a new glucose meter at no cost. Test strips can be purchased from either a network pharmacy or durable medical equipment supplier. The $0 copayment on Accu-Chek and OneTouch test strips will apply at both preferred and standard pharmacies. Providers may appeal if they feel a member is unable to use Accu-Chek or OneTouch test strips and glucose meters. Note: Independence Medicare Advantage plans will continue to offer a $0 copayment on all brands of lancets and solutions.Continue reading > >
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More Medicare Change Needed
Even with these latest changes, many see a need for more Medicare reform across the board.
When the COVID-19 pandemic began in 2020, CMS eased some of their coverage restrictions temporarily including a push toward telehealth as shelter-in-place orders forced PWDs across the globe to stay at home rather than travel to clinics or doctors offices. Those revisions were extended through 2021 and have become more established.
Yet, the cost and access barriers for CGM use remain a significant burden for most PWDs, and Communities of Color who are already disproportionately hit by diabetes are even more likely to be hit by these barriers.
This is important, given that studies show how
Does Medicare Cover Blood Pressure Monitors
Blood pressure is one of the most important health signs to monitor. Your blood pressure is the force within your blood vessels that keeps the blood moving throughout your circulatory system. Blood pressure needs to be maintained at a certain level to ensure nutrient, oxygen, and waste transportation is effective.
Blood pressure monitors provide a critical and helpful tool to help track levels and ensure that you are healthy and that no additional health problems arise. Medicare insurance provides a few options that allow coverage for blood pressure monitors.
Why is Blood Pressure Important? Blood pressure is controlled by the diameter of your blood vessels and the force with which the heart contracts. This pressure is highest in the heart and gradually lowers as the arteries work their way through the body. This change in pressure is what allows the blood to continually circulate. The blood vessels are also elastic in nature, allowing them to widen or tighten depending on blood flow and the changes in pressure.
Without a healthy blood pressure, your blood would not be able to transport oxygen and other nutrients to all areas of your body. This is important for keep your cells energized and healthy. Low blood pressure can also leave waste products and toxins in cells and important organs, such as the kidneys and liver. This can reduce functionality and lead to further health issues if left untreated.
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Medicare To Cover Therapeutic Cgm Sets Criteria
For Medicare patients on continuous glucose monitoring , the news is good. The Centers for Medicare and Medicaid Services will cover therapeutic continuous glucose monitoring , and have set the criteria that must be met. In the past, it has not been covered.
CMS announced the criteria decision March 23, following their January ruling about granting coverage for CGM. 1
The coverage decision is a game changer for our Medicare patients, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE. She is program coordinator for the Teen and Adolescent Diabetes Transition Program at the University of Chicagos Kovler Diabetes Center and a member of the editorial board for EndocrineWeb.
The decision is long overdue, says J. Michael Gonzalez-Campoy, MD, PhD, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology in Eagan, MN, and a member of the editorial board for EndocrineWeb. The medical literature clearly documents that enhanced monitoring improves outcomes in the treatment of diabetes.
The coverage is effective for service dates Jan. 12, 2017 and later, according to CMS.
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How Much Does Freestyle Libre Cost Out Of Pocket
GoodRx reports that the cost of the FreeStyle Libre ranges from $120 to $131. The amount you would pay out of pocket varies based on where you live and which retailer you buy from. In addition to the device, you will need to purchase additional supplies on a monthly basis. A study published in the journal US Endocrinology found that the overall cost of using the FreeStyle Libre 14-Day System for one year is $1,602.76.
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How Do I Get Medicare To Cover Cgm
For Medicare to cover a continuous glucose monitor, you need to:
- Pay your Part B premium and the 20% of the cost that you’re responsible for
- Have already met your Part B deductible
- Get a prescription for a CGM from a Medicare-participating doctor
- Purchase your CGM from a Medicare-approved provider
- See your doctor for checkups once every six months
How To Sign Up For Medicare
If you are close to turning 65 and are not getting Social Security or Railroad Retirement Board benefits, you must sign up for Medicare. Even if you are eligible for premium-free Part A coverage, you still must enroll.
If you arent getting Social Security benefits, you will not automatically receive any information from Medicare. You must call Social Security at least three months before the month you turn 65 to avoid any late penalties.
To be eligible for Medicare, you must meet these requirements:
- You are turning 65 or have a qualifying disability.
- You or your spouse worked and paid Medicare taxes for at least 10 years.
- You are a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.
- You are receiving Social Security or RRB benefits or have worked long enough to be eligible for those benefits but are not collecting them yet.
You can sign up for Medicare during:
- Your Initial Enrollment Period
- A Special Enrollment Period
- The General Enrollment Period
To enroll, you can:
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Get In Touch To Learn More About How To Get Started On Eversense
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Disclaimer
The Eversense® Continuous Glucose Monitoring System is indicated for continually measuring glucose levels in persons age 18 and older with diabetes for up to 90 days. The system is indicated for use to replace fingerstick blood glucose measurements for diabetes treatment decisions. Fingerstick BG measurements are still required for calibration twice per day, and when symptoms do not match CGM information or when taking medications of the tetracycline class. The sensor insertion and removal procedures are performed by a Health Care Provider. The Eversense CGM System is a prescription device patients should talk to their Health Care Provider to learn more. For important safety information, see Safety Information.
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