We are excited to introduce the FreeStyle Libre System to our patient base and new customers seeking alternatives to traditional blood glucose monitors. In particular this product represents an opportunity for our Medicare beneficiaries whom are testing four times per day or more, and are injecting insulin three times per day or more or are on an insulin pump.
Who is Eligible for Continuous Glucose Monitoring (CGM)?
Medicare now covers Continuous Glucose Monitoring (CGM) which makes this product accessible to Medicare Beneficiaries alongside other patients whom have Medicare Advantage or Medicare Replacements. Patient with plans outside of Medicare might also be eligible their ability to access Continuous Glucose Monitoring (CGM) would be based on their plan’s coverage determinations.
If you are of Medicare age and have any questions please contact usso we can help you review your options. Whether we can be of service or not we will do our best to help you understand what your options are in regards to Continuous Glucose Monitoring (CGM).
For patients whom have Medicare and for those whom have insurance plans that follow Medicare guidelines the criteria to ensure coverage is as follows:
When does Medicare Cover Continuous Glucose Monitoring (CGM)?
Therapeutic Continuous Glucose Monitoring (CGM) and related supplies are covered by Medicare when all the following coverage criteria are met:
The beneficiary has diabetes mellitus; and
The beneficiary has been using a blood glucose monitor (BGM) and performing frequent (4 or more times a day) testing; and
The beneficiary is insulin-treated with multiple (3 or more) daily injections of insulin or a Medicare covered continuous subcutaneous insulin infusion (CSII) pump; and
The beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of Blood Glucose Monitoring (BGM) or Continuous Glucose Monitoring (CGM) testing results; and
Within six (6) months prior to ordering the Continuous Glucose Monitoring CGM, the treating practitioner has an in-person visit with the beneficiary to evaluate their diabetes control and determined that criteria (1-4) above are met; and
Every six (6) months following the initial prescription of the Continuous Glucose Monitoring CGM, the treating practitioner has an in-person visit with the beneficiary to assess adherence to their Continuous Glucose Monitoring CGM regimen and diabetes treatment plan.
How can I make sure Medicare Covers my Continuous Glucose Monitoring (CGM)?
If you meet the four times per day testing criteria along with the three times per day injection or are on a pump criteria, qualifying for Continuous Glucose Monitoring (CGM) is easy! We can help you ensure you are abiding by Medicare’s coverage criteria.
How long does it take to receive my Continuous Glucose Monitoring (CGM) Device?
Many of our patients qualify and are ready to ship their Continuous Glucose Monitoring (CGM) system within seven days of beginning the process! Those who do a thorough job of understanding the requirements can have their Continuous Glucose Monitoring (CGM) system shipped within two-three business days. To better prepare you please ensure to read through the above and below.
Discuss Continuous Glucose Monitoring (CGM) with your Doctor—
If you and your doctor agree Continuous Glucose Monitoring (CGM) is a good option for you, let us know and we will send you Medicare Compliant Certificate of Medical Necessity/ Prescription Order / Rx and all of the requirements in an easy to digest format. Ensuring to have the doctor fully complete and sign off on the Prescription order is a key step to ensuring a prompt turn around on your order. Prescription orders are generally valid for one year unless there have been any changes to the details provided on the Certificate of Medical Necessity/ Prescription Order / Rx.
Additional Tips for ensuring coverage and speedy delivery of your Continuous Glucose Monitoring (CGM).
In addition to all items stated above it is important that Medicare Beneficiaries and those whom have Medicare Advantage, Medicare Replacement or other plans that follow Medicare guidelines work with their physicians to ensure:
Medical records provided to substantiate qualifying Continuous Glucose Monitoring Criteria (CGM) must clearly indicate the above requirements.
Each qualifying Medical Record / Office Visit / Chart Note must be Signed and Dated by your physician. Signatures that are electronic must be labeled as electronically by and must also have a corresponding date. The qualifying Medical Record / Office Visit / Chart Note must be Signed and Dated within two weeks of the office visit date.
You may utilize a Testing Log to meet the times testing criteria. Your testing log must be a part of your medical record and have been signed and dated by your prescriber in order to be considered. Your testing log must reflect 28 days of consecutive testing and must reflect an average of 4 times per day or more testing to qualify. Your testing log must contain a date span from within 3 months of your order to qualify.
You will need to ensure your qualifying Medical Record / Office Visit / Chart Note on file is from within 6 months of your order.
Thank you for reviewing all of the above!
Please contact us with any questions at all you may have—
Pharmacist is available for consultations as follows: Monday through Friday 9:30am – 5:00pm, Saturday: 8:00am – 12:00pm, and Sunday: Closed. In the case of an emergency, please call 911.
*No cost offer applies to qualified beneficiaries and dependent on enrollment, co-pays and deductibles may apply. †Cooler bag offer dependent upon enrollment in home delivery program, while supplies last, Not available to current ADS patients. Terms and conditions apply. The information presented here is meant to be strictly for informational and educational purposes. It is not to be considered as advice, including medical advice, from NorthCoastMed.com, or any associated company. None of the information is intended to serve as a substitute for diagnosis from, or consultation with, a health care professional. Always consult your doctor regarding any medical questions that you have, as well as before starting or changing your exercise or diet program, and before adjusting any medication