Alternate Site Blood Glucose Monitors
Aetna considers alternate site blood glucose monitors medically necessary DME for the following persons with diabetes, when an alternate site blood glucose monitor is recommended by their physician:
Alternate site blood glucose monitors have no proven value over standard blood glucose monitors for other indications.
Continuous Glucose Monitoring Following Gastric Bypass And For Nesidioblastosis
Hanaire et al stated that hypoglycemia is rare after a gastric bypass and can be taken for a dumping syndrome. There is no report in the literature of the contribution of continuous glucose monitoring to the diagnosis of hypoglycemia in these circumstances. The present case report showed that CGM can be a useful tool for the diagnosis and the management of such episodes. Continuous glucose monitoring revealed hypoglycemic episodes in free living circumstances that were not present during 72-hr fasting. These episodes followed wide hyperglycemic swings. No such episode resumed over 8 months after specific dietary advices and treatment by 50 mg TID of acarbose. Because hypoglycemia can be difficult to diagnose from dumping syndrome, CGM is a very useful tool revealing the episodes in free-living circumstances and can be used to monitor the treatment success. The findings of this single-case study need to be validated by well-designed studies.
UpToDate reviews on “Medical management of patients after bariatric surgery” and “Complications of bariatric surgery” do not mention the use of continuous glucose monitoring.
Therapeutic Shoes Or Inserts
If you meet certain conditions Medicare will cover either a pair of depth-inlay shoes with three pairs of inserts OR a pair of custom-molded shoes with inserts every year. Individuals only qualify for custom-molded shoes if they have a foot deformity that prevents them from wearing in-lay shoes.
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Medicare Eligibility For A Therapeutic Cgm
A therapeutic CGM is a medical device approved by the U.S. Food and Drug Administration as a replacement for home blood sugar monitors. It provides you and your doctor with the medically necessary information to make diabetes treatment decisions, such as changes in diet and your insulin dosage.
To qualify for a therapeutic CGM, you must be undergoing treatment for diabetes and meet certain other criteria.
To be eligible for a therapeutic CGM under Medicare, you must meet the following requirements.
- You are using insulin to treat Type 1 or Type 2 diabetes.
- You need to check your blood sugar four or more times per day.
- You must use an insulin pump or receive three or more insulin injections per day.
- You must make routine, in-person visits to your doctor.
- Your doctor has determined that you meet all Medicare eligibility requirements.
The decision between a therapeutic CGM or a traditional monitor is one you should make after talking to your doctor. A therapeutic CGM may be a better option if you use insulin and frequently change your dosage.
How Do I Get My Medicare Diabetes Supplies
You can order and pick up supplies from your pharmacy, or you can order them from a DME supplier.
If you order from a supplier, you must place the order yourself, meaning a doctor cannot call it in for you. However, you will still need a prescription from your doctor to place the order.
When you go to the pharmacy or supplier, show your red, white and blue Medicare card and your prescription.
You can also order supplies through the Medicare National Mail-Order Program, including test strips, lancets and lancet devices. If you want your supplies mailed to your home, you must use a Medicare national mail-order contract supplier. You can visit www.Medicare.gov or call Medicare for a list of contracted suppliers.
You need a new prescription from your doctor for lancets and test strips every 12 months, so dont forget to ask for refills for your supplies every year.
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What Do Medicare Prescription Drug Plans Cover
Medicare prescription drug plans cover certain diabetes-related prescription drugs. This coverage is available through private Medicare-approved insurance providers. You can get this coverage either as a stand-alone Medicare Part D prescription drug plan that works alongside your Original Medicare insurance or by enrolling in a Medicare Advantage Prescription Drug plan which includes your Medicare coverage along with prescription drug coverage all in one plan.
Medicare prescription drug plans may cover the costs of items such as:
- External insulin pumps
- Anti-diabetic drugs used to maintain blood sugar levels Insulin-related supplies, such as syringes, alcohol swabs, needles, gauze, and insulin inhalers.
Medicare prescription drug plans can vary by provider. Before enrolling in a plan, check to make sure that your diabetic needs will be met. Every plan has a formulary, which is a list of covered drugs. You can review the formulary before deciding to enroll. Joining a Medicare prescription drug plan means you are responsible for a copayment, and, depending on the plan details, a deductible may apply when you buy anti-diabetic drugs or diabetic supplies.
Other Useful Information On Diabetic Supplies
- Generally, you pay 20% of Medicare-approved amounts for your supplies, and the Medicare Part B deductible applies.
- Make sure you refill your supplies in a timely manner, and only accept supplies you have requested. Medicare wont pay for supplies you didnt order for example, if a supplier automatically sends you items, you cannot get reimbursed by Medicare.
- You may rent or purchase certain diabetic supplies. For more information, call 1-800-MEDICARE . TTY users call 1-877-486-2048. Customer service representatives are available 24 hours a day, seven days a week.
- Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment for diabetes. If the supplier is a participating supplier, he or she must accept assignment. If the supplier is enrolled in Medicare but isnt participating, he or she has the option to accept assignment or not. If a DME supplier doesnt accept Medicare assignment, there is no limit to what you can be charged. You also may have to pay the entire bill at the time you get the DME.
- All Medicare-enrolled pharmacies and suppliers must submit claims for diabetic testing supplies. You cant send in the claim yourself.
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Diabetes Screenings And Services
Not only does Medicare cover diabetic supplies, but they also cover diabetes services and preventative services for those at risk. In general, Medicare pays for 80% of the visit and you will pay 20% if you do not have coinsurance. This can also apply to your deductible. These screenings and services include:
- Self-management training
- Flu and pneumococcal shots
- A Welcome to Medicare preventive wellness visit
If you require diabetic supplies and would like to get them through the mail, use Medicares list of approved national mail-order contract suppliers online. Visit medicare.gov/supplier, enter your zip code, and click Search.
How Much Do Testing Supplies Cost
If youve met your Part B deductible , you will pay 20 percent of the Medicare-approved amount for diabetic testing supplies. Medicare pays the other 80 percent.
Depending on the type of equipment or supplies you need, you may need to:
- rent the equipment.
- buy the equipment.
- choose whether to rent or buy the equipment.
Additionally, your durable medical equipment will only be covered if your doctors and DME suppliers are enrolled in Medicare. You must also purchase your testing supplies from a supplier who accepts assignment. In this case, they can only charge you the coinsurance and Part B deductible.
Accepting assignment means the supplier agrees to be paid directly by Medicare and accepts the payment amount Medicare approves for the service. The Medicare-approved amount is the amount a supplier can be paid by Medicare, and you pay the rest.
To ensure your supplier is enrolled in Medicare, ask if they participate in Medicare before you order the supplies.
How much you will specifically pay for supplies depends on a variety of factors such as:
- Other insurance you may have.
- How much your doctor charges.
- Where you get your supplies.
- Whether your doctor and supplier accept assignment.
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Is There Medicare Coverage For Insulin Pumps And Insulin
If you meet certain medical conditions and your doctor believes an external insulin pump is medically necessary to treat your diabetes, Medicare may cover 80% of the allowable charges for the pump. You generally pay 20% plus any applicable deductible.
If you are approved for an insulin pump, Part B also may cover the insulin used in the pump. Insulin pumps and related diabetic supplies are considered DME both your doctor and your diabetic supplies provider must participate in the Medicare program in order for them to be covered.
How Can I Get An Affordable Continuous Glucose Monitor
People who arent eligible for a continuous glucose monitor through Medicare may still be able to access an affordable device. Start by checking your health insurance to see if monitors are covered.
If you cant get a monitor through health insurance, you can try contacting the manufacturers. Many companies offer financial assistance to qualifying customers to help them access monitoring technology, including free trials and ongoing discounts for supplies.
Speak to your doctor if you want to try a continuous glucose monitor. Some doctors have stocks of supplies that theyre willing to share, and clinics may have professional continuous glucose monitors that they loan out. These are used for a short time to get a snapshot of your glucose data and gauge the effectiveness of your diabetes management.
Finally, you can look for an affordable supplier. More monitoring systems are becoming available through pharmacies, and these are generally less expensive than ordering direct through manufacturers.
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Glutamic Acid Decarboxylase Autoantibodies
Aetna considers measurement of autoantibodies to GAD medically necessary for distinguishing type 1 from type 2 diabetes when the clinical history is ambiguous and the results of testing will influence patient management. Measurement of anti-GAD antibodies is also considered medically necessary in diagnosing stiff-person syndrome. Anti-GAD antibody measurement is considered experimental and investigational for predicting the onset of diabetes and for all other indications.
How To Save On Diabetic Supplies
For those wanting to save on diabetic supplies, there are a few options that can help cover the costs Medicare does not.
- If you have limited income and resources, look to see if you qualify for Medicaid services, Medicare Savings Programs, or Medicare Extra Help.
- Manufacturer rebates may also be available for specific diabetic supply brands.
- There are also a wide variety of organizations that offer patient assistance programs for diabetic medication and supplies.
- Cutting down on excessive use of diabetic supplies can also help save money. Not everyone needs to test multiple times a day, Hudson says. If I had a patient with well-controlled diabetes on oral medications, I might have them only test their blood sugar once a day or even once every other day.
- If you need help paying for your anti-diabetic drugs or insulin, the SingleCare discount card is a great option.
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Medicare Diabetes Prevention Program
Medicare offers a health behavior change program called the Medicare Diabetes Prevention Program. The idea is to help you prevent the onset of type 2 diabetes. Part B covers the entire cost when you meet the program requirements.
The following must apply for Part B to pay for the Medicare Diabetes Prevention Program:
- A BMI of or above 25 or 23+ if youre Asian
- Never diagnosed with type 1 or 2 diabetes
- Never participated in the program before
- Received a test result between 5.7 and 6.4%
- Never diagnosed with End-Stage Renal Disease
After joining, the program starts with 16 core sessions that you receive for six months. Each session is in a group setting. The benefits of the program are to help change long-lasting behaviors. The program teaches tips on how to exercise more and managing your weight. Get support from people with like-minds and goals.
Medicare And Diabetes Coverage
Home / FAQs / Medicare Coverage / Medicare and Diabetes Coverage
Medicare and diabetes coverage is a concern for many Americans. Diabetes can cause a persons health and well-being to deteriorate over time. Close monitoring is often necessary because diabetes causes other health concerns and conditions. Below we go into full detail about what you need to know regarding Medicare and diabetes coverage.
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Does Medicare Cover Insulin Or Prescription Drugs To Treat My Diabetes
Original Medicare generally doesnt cover injectable insulin or prescription medications to treat diabetes. If you want help paying for injectable insulin and diabetic supplies related to insulin injections, or other prescription medications your doctor orders, you may choose to enroll in a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Part D Prescription Drug Plan. If you have either of these types of Medicare prescription drug coverage, your plan might cover:
- Injectable insulin not used in an insulin pump, plus insulin-related diabetic supplies such as alcohol swabs, syringes, needles, and gauze.
- Inhaled insulin and inhaler devices
- Anti-diabetic prescription drugs
Each plan uses a formulary, or list of prescription drugs it covers. A plans formulary may change at any time. When required by law, you will receive notice from your plan of changes to the formulary.
You may have copayments, coinsurance, and deductibles with your Medicare Part D prescription drug coverage, and additional monthly premiums may apply. You may also be required to use providers in your plans network to access benefits, depending on the plan you choose.
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Continuous Glucose Monitoring Devices
Aetna considers the short-term diagnostic use of continuous glucose monitoring devices medically necessary for persons with diabetes who have either of the following problems in controlling blood glucose level, unresponsive to conventional insulin dose adjustment:
Aetna considers the short-term diagnostic use of continuous glucose monitoring devices medically necessary to diagnose primary islet cell hypertrophy or persistent hyperinsulinemic hypoglycemia of infancy in persons with symptoms suggestive of recurrent hypoglycemia.For short-term diagnostic use, no more than 2 continuous glucose monitoring periods are considered medically necessary within a 12-month period.
Aetna considers experimental and investigational the long-term use of continuous glucose monitors for individuals with type 1a glycogen storage disease, persons with type 2 diabetes not using intensive insulin regimens, nesidioblastosis , neonatal hypoglycemia, and for monitoring blood glucose in non-diabetic persons following gastric bypass surgery because there is insufficient evidence of the clinical benefits of this approach for these indications.
Measurement Of Advanced Glycation End Products By Skin Autoflourescence
Skin autofluorescence is a non-invasive measurement of the level of tissue accumulation of advanced glycation end products , representing cumulative glycemic and oxidative stress. Several studies have shown that AGEs accumulate in skin faster in individuals with poor blood sugar control and that measurement of AGEs by skin autofluorescence may be able to predict the risk of developing diabetes and related complications .
The Scout DS system measures skin AGEs by autoflorescence spectroscopy. The device is a portable desktop system with an arm cradle. The subject places the palm side of their forearm into the cradle and the device shines multiple wavelengths of light into the skin causing the AGEs to fluoresce. The instrument optically calibrates for skin pigmentation, making the measurement impervious to variations in skin color. A specially designed fiber-optic probe sends excitation light to the subject and relays resulting skin fluorescence to the detection module. A value from 0 to 100 representing the likelihood of that subject having an abnormal glucose tolerance test is reported in about 60 seconds. The proposed benefits of the Scout DS system is that the patient would not need to fast or provide a blood sample and results are received much quicker. The system is not intended to replace an oral glucose tolerance test.
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