Does OM cover CGMs or not?

[axeman462]

It's my understanding that CGMs are covered by Part B.

Had a customer call today said she went to Walgreens and they told her the Libre 3 ain't covered by Medicare, but "maybe" Libre 2 is.

But on Abbots website, they imply that the 3 is covered. Am I missing something?

 

[somarco]

The general answer to your question is . . .

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.
https://www.medicare.gov/coverage/therapeutic-continuous-glucose-monitors

and . . .

Blood sugar monitors
Medicare Part B (Medical Insurance) (tooltip) covers blood glucose (blood sugar) monitors as durable medical equipment (DME) that your doctor prescribes for use in your home.
Your costs in Original Medicare
After you meet the Part B deductible , you pay 20% of the Medicare-approved amount (tooltip) (if your supplier accepts assignment (tooltip) ). Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

You may need to rent the equipment.
You may need to buy the equipment.
You may be able to choose whether to rent or buy the equipment.
Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask a supplier if they participate in Medicare before you get DME. If suppliers are participating in Medicare, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare‑approved amount). If suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you.
https://www.medicare.gov/coverage/blood-sugar-monitors


Beyond the above criteria, not all CGM's are approved by Medicare.

The Abbott/Freesstyle page refers to "systems" covered by Medicare but seems to stop short of expressly stating if the Libre 3 is covered.

If you have Medicare, you may be covered for the FreeStyle Libre 2 or 3 system if you meet all of the following coverage criteria1:


[EXTERNAL LINK] - Medicare Coverage | FreeStyle Libre US


Finally, does Walgreens accept Medicare assignment and is approved to file Part B claims?

 

[straightnochaser]

As long as they're being treated by Insulin CGM's are covered, the prerequisites were recently changed.

Freestyle Libre 3 is covered - I helped a client recently get one (although this was MAPD, OG Medicare may be different)

 

[axeman462]

thank you both.
I talked to the client again this afternoon. I somehow missed the fact that she is pre-diabetic, so she would not qualify. While the doctor wants her to monitor her blood sugar so she don't get diabetes, she does not use insulin.
This makes sense now, thank you both again for your guidance. Enjoy the rest of the selling season