Tuesday, July 16, 2024

What Brand Of Glucose Meter Is Covered By Medicare 2020

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What Is Freestyle Libre

Best Glucose Meters And Monitor 2020

FreeStyle Libre is a continuous glucose monitoring system that allows a person to check their blood sugar in real-time without having to prick their finger.

The system has two components: a glucose sensor that the person applies to the skin and a digital reader. A person can apply the sensor to the back of their upper arm and leave it in place for a maximum of 14 days.

The sensor monitors a persons blood glucose by measuring glucose levels in the interstitial fluid, which is the fluid between the cells and the blood vessels. A person can hold the digital reader over the sensor to obtain a blood glucose reading.

More Cgms Now Covered By Medicare

In March 2022, Medicare beneficiaries became eligible for coverage for a greater number of CGMs than ever before. Due to a final rule issued on December 21, 2021 by the Centers for Medicare and Medicaid Services , any CGM that connects with an insulin pump or a standalone receiver will be covered by Medicare for anyone otherwise eligible. This rule took effect at the beginning of this month, so people with Medicare now have access to Dexcom G6, Abbott Freestyle Libre, Senseonics Eversense and Medtronic Guardian, as long as these CGMs are used with an insulin pump or with use of a standalone receiver.

Previously, CMS only covered therapeutic CGMs which are those devices approved by the Food and Drug Administration to make insulin dosing decisions. This expansion means that people on Medicare with diabetes will now have access to a broader choice of CGMs similar to what is available to those with commercial insurance.

In July 2021, CMS announced that people with diabetes no longer needed to prove that they are testing their blood sugar at least four times per day with a blood glucose meter to get initial Medicare coverage for a CGM device. Additionally, language was clarified to allow individuals using inhaled insulin, not just injected insulin, to access CGM. To read more about this, read our blog post here.

All of these recent changes are long-sought advocacy goals for JDRF and welcome news for members of the T1D community.

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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 its 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 > >

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How Accurate Are Cgm Systems

CGM accuracy is measured by the MARD score, which stands for Mean Absolute Relative Difference. It represents the difference between laboratory glucose readings and the actual reading from the CGM. The lower the difference, the more accurate the device.

Dexcom G6:

CGMs have been around for years, but the new models are better than ever, and are covered by Medicare and most private insurance.

Why Should You Buy The Best Free Blood Glucose Meter At Amazon

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Free Blood Glucose Meter

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What Do I Need From My Doctor To Get These Covered Supplies

Medicare will only cover your blood sugar self-testing equipment and supplies if you get a prescription from your doctor. The prescription should include:

  • Whether you have diabetes.
  • What kind of blood sugar monitor you need and why you need it.
  • Whether you use insulin.
  • How often you should test your blood sugar.
  • How many test strips and lancets you need for one month.

Where can I get these supplies?

  • You can order and pick up your supplies at your pharmacy.
  • You can order your supplies from a medical equipment supplier. Generally, a âsupplierâ is any company, person, or agency that gives you a medical item or service, except when youâre an inpatient in a hospital or skilled nursing facility. If you get your supplies this way, you must place the order yourself. Youâll need a prescription from your doctor to place your order, but your doctor canât order the supplies for you.

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Glutamic Acid Decarboxylase Antibodies

Glutamic acid decarboxylase is an enzyme that is produced primarily by pancreatic islet cells. A number of recent studies indicate that patients with type 1 diabetes often have antibodies to GAD and several other islet cell antigens. This is consistent with the hypothesis that type 1 diabetes is an autoimmune disease and that autoantibody production is an early step in the development of type 1 diabetes. Autoantibodies can be detected in many cases prior to the onset of glucose intolerance. The presence of GAD autoantibodies has been shown to be a strong predictive marker for the eventual onset of type 1 diabetes.

Measurement of anti-GAD antibody can be of use in distinguishing type 1 from type 2 diabetes when the clinical history is ambiguous. Guidelines from the Royal Australian College of General Practitioners explained that measurement of GAD can be of particular use in diagnosing Late onset Autoimmune Diabetes in Adults , a form of late onset diabetes that is autoimmune and requires treatment with insulin within a relatively short period of time after diagnosis . RACGP guidelines explained that persons with LADA tend to be young . The guidelines stated that testing for GAD antibodies can confirm the diagnosis in ambiguous cases and prompt counseling the person about the likely time course of diabetes progression and the possibility of other autoimmune disease. In addition, the establishment of the LADA diagnosis may be useful in selecting therapy

How To Monitor Glucose Levels

Diabetes Management: Using a Glucometer

According to the NIH, one way to monitor your glucose levels is by using a finger-stick device to collect a drop of blood, which you put into a glucose monitor on a set schedule each day. An alternative site glucose monitor allows blood samples from areas such as your palm or thigh, according to the Mayo Clinic.

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What Medicare Members Would Pay

CMS had originally proposed three different categories of payment for those using the different types of CGM technology. The logic was that some didnt require fingersticks so users wouldnt need reimbursement for test strips, as would other systems that still require calibration . It also viewed the FreeStyle Libre flash glucose monitoring a bit differently than other tech, like Dexcom and Eversense. So it proposed different reimbursements for those varying styles of tech.

However, CMS has re-thought that move after public outcry. In its new December 2021 rule comments, the agency noted this:

After consideration of public comments, CMS does not believe it is necessary at this time to further stratify the types of CGMs beyond the two categories of non-adjunctive and adjunctive CGMs.

What Other Cgms Or Insulin Pumps Does Medicare Cover

Medicare also covers the Dexcom G5 CGM, which is another continuous glucose monitoring system.

The Dexcom G5 and FreeStyle Libre are different than insulin pumps, which can monitor and administer insulin. Medicare also covers some types of insulin pumps. A person can talk to their doctor about what monitoring approach may be best for them.

The federally funded health insurance program called Medicare includes:

  • Part A, which offers hospital insurance coverage
  • Part B, which provides coverage for medical insurance
  • Part C, also known as Medicare Advantage, which offers an alternative to original Medicare
  • Part D, which offers prescription drug coverage

Medicare considers designated blood glucose monitoring systems, such as FreeStyle Libre, to be durable medical equipment . Therefore, Medicare Part B will help pay for a portion of the costs.

However, some qualifying requirements apply, including:

  • A doctor must certify that the monitor is medically necessary and prescribe it.
  • Both the prescribing physician and the supplier must accept Medicare assignment.
  • A person must test their blood sugar levels at least four times a day and use insulin injections at least three times daily.

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What Are The Key Differences Between The Medicare Version Of Freestyle Libre And G5

These product differences will change over time some potentially this year. For instance, Dexcoms next-gen G6 is currently under FDA review, with plans to launch before the end of 2018. It is currently under review for one fingerstick calibration per day and 10-day wear, but FDA discussions are also underway for a no-calibration version. Meanwhile, Dexcoms next-next-gen sensor with Verily requires no calibration, will be fully disposable, and last 10 or 14 days. Abbott is currently developing a next-gen FreeStyle Libre as part of its Bigfoot partnership, which will add continuous communication to the FreeStyle Libre sensor. Wed guess it could add alarms too, but this is speculation on our part.

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What Should Providers Do When Contacted By Cms Regarding Their Cgm Device Billing History

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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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Medicare And Cgm Coverage

When the food and drug administration gave the green light for people to make dosing decisions based on CGM results, Medicare began covering CGMs. The decision was put into effect in January 2017. The coverage ruling saves people between $2,500 to $4,000 a year who might otherwise purchase the equipment out of pocket. Michael Gonzalez-Campoy, MD, Ph.D., Medical Director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology, claims that based on the studies hes read, CGMs provide the kind of enhanced monitoring that improves diabetes treatment.3

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How To Get Diabetes Supplies Through Medicare Part B

To get your diabetes supplies under Medicare Part B, you need a prescription from your doctor. The prescription should state:

  • That you have been diagnosed with diabetes
  • What kind of blood glucose monitor and test strips you need and why
  • How often you should test your blood sugar each day
  • Whether you use insulin
  • How many test strips and lancets you need a month
  • Note: For quality products, ask your doctor to prescribe an Accu-Chek® Guide Me blood glucose monitor and Accu-Chek Guide test strips. They can even include the phrase âDo Not Substituteâ to make sure you get the brand you want.
  • Simply hand one of the Medicare cards shown here and your prescription to your pharmacist when you go to the pharmacy.

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    Does Medicare Cover Dexcom G6

    Glucose monitoring technology, including continuous glucose monitoring systems, plays a vital role in protecting the health of individuals who suffer from issues related to blood sugar and insulin production. In the past, individuals who needed to check their blood glucose levels would typically need to obtain a blood sample, often through a prick on the finger, and the sample would then need to be manually inserted into a testing device for analysis. Unfortunately, this method can be time-consuming, and it relies on the user remembering to take measurements at various times throughout the day. This could also mean missing regular testing during the night due to sleep.

    Today, however, advanced glucose monitoring using technology like the Dexcom G6 can provide real-time data 24 hours a day for people who need continuous monitoring. Modern monitoring provides important information regarding overall health as it relates to glucose levels, allowing for faster treatment in the event of an emergency. This is vital for patients who are diabetic or for patients who may be at risk for developing health conditions related to fluctuating or uneven blood glucose.

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    The Benefits Of Glucose Meters

    Dexcom G6 vs Freestyle Libre – Endocrinologist review and comparison [2020]

    Self-monitoring blood sugar with a glucose meter is beneficial for people with diabetes in several ways:

    • It allows you and your doctor to detect hyperglycemic and hypoglycemic episodes, giving you encouragement and an improved sense of health.
    • Long-term success with blood sugar control leads to decreased heart, kidney or eye disease complications.
    • This advanced technology is highly accurate and increases your understanding of managing your diabetes by giving you more self-care responsibility and motivating you toward healthier lifestyle changes.
    • The convenience of home glucose monitoring allows you to test often without visiting your doctors office, saving you time and money.

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    Applied Behavior Analysis Medical Necessity Guide

    The Applied Behavior Analysis Medical Necessity Guide helps determine appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

    Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member’s benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

    The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered for a particular member. The member’s benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

    Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

    What Are Blue Cross Tier 1 Drugs

    Tier 1 – Generic: All drugs in Tier 1 are generic and have the lowest possible copayment. A copayment is a fixed amount you pay when you get a prescription filled or receive other health care services. Drugs listed as Tier 1 are preferred because they offer the best combination of value and effectiveness.

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    Does Medicare Cover Glucose Meter And Supplies

    Glucose meters are portable devices that measure blood sugar. They are also known as glucometers.

    You must meet the following requirements for Medicare to cover your glucose meter:

    • You have been diagnosed with diabetes
    • Your doctor has stated that a professional can train you to use this device
    • If you cant operate the device, another person will be available to do it for you
    • The monitor is for use in your home, rather than clinical use

    Medicare Part B covers 80% of the Medicare-approved cost of glucose meters and the supplies needed to operate them after you meet the Part B deductible. These supplies include:

    • blood sugar testing strips
    • glucose control solutions that check the accuracy of your at-home equipment

    Medicare will cover these costs whether or not you use insulin. If you use insulin, you may be eligible for a larger quantity of test strips and other supplies than you would be if you dont use insulin.

    Typically, a person who uses insulin will have Medicare coverage for 300 test strips and 300 lancets every three months. If you dont use insulin, youll have coverage for 100 test strips and 100 lancets every three months.

    If your physician can prove that its medically necessary for you to receive more supplies than your eligibility indicates, you may be able to get them.

    For coverage to take place, your physician and medical supplies provider must both accept Medicare assignment.

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