![]() The crucial part of this policy is the mention of supplies billed separately being denied because of being “unbundled.”īundled versus unbundled. So yes, you can get test strips under Medicare as part of your CGM supplies. Supplies or accessories billed separately will be denied as unbundling.” “For non-adjunctive CGMs, the supply allowance (K0553) also includes a home BGM and related supplies (test strips, lancets, lancing device, calibration solution, and batteries), if necessary. I am writing about Basic Medicare with or without a Supplement Plan.)Īs stated above, Dexcom is labeled as a therapeutic and non-adjunctive CGM. Similarly people with TRICARE and retiree plans can have different benefits. (Please note that Advantage Plans are Medicare benefits administered by private companies and can have different rules than Medicare. Only now have I run out of those strips and need to investigate my alternatives.ĭespite the different experiences of Medicare recipients in getting test strip coverage along with CGM coverage, Glucose Monitor – Policy Article A52464C clearly outlines the policy. It wasn’t a big deal to me because I had lots of extra strips that I used well past their expiration dates. All of a sudden many of us were no longer getting test strips. Fast forward to Dexcom G6 when Dexcom quit being a Medicare distributor and moved us to Walgreens and online DME suppliers. Meanwhile some pharmacies quit providing test strips to seniors on CGM due to Medicare denying payment because we were getting test strips from Dexcom. At that point Contour Next was rated as the most accurate meter by the Diabetes Technological Society (DTS). ![]() What was amazing was that Dexcom picked a high quality meter system (Contour Next by Bayer) for Medicare recipients rather than the cheapest kid on the block. When Dexcom began providing Dexcom G5 to Medicare recipients in 2017, we were shipped a blood glucose meter and test strips packaged with our monthly sensor allowance. Finally for better or worse a clear delineation of the policy. Then a few days ago a Facebook friend posted a link to Glucose Monitor – Policy Article A52464C as updated on 4/7/22. All of my info was from word-of-mouth on diabetes social media. I started this blogpost ten days ago writing that I could find no CMS document outlining the exact guidelines for test strip coverage. But it was not the meter and strips of my choice. I have read many times our Medicare CGM suppliers are required to provide a meter and I recently got a meter and strips from Solara. Others have had no success getting pharmacy coverage for strips regardless of what the prescription specifies. ![]() A few people on Facebook claim to get coverage for 3 strips a day (the Medicare allowance for insulin users) from their pharmacy because the doctor wrote the prescription saying that the strips were for calibrating their Dexcom. Some seniors on Advantage Plans are able to get test strips in addition to CGM with no problem. Like everything with Medicare, people are having totally different experiences with the test strip problem. ** Per CMS Policy Article A52464: “A therapeutic or non-adjunctive CGM can be used to make treatment decisions without the need for a stand-alone BGM to confirm testing results.” But unfortunately for many of us seniors, the labeling of Dexcom as therapeutic and non-adjunctive** has made it more difficult to receive Medicare-reimbursed test strips or at least the test strips of our choice. One less chore in my diabetes life and fewer alarms interrupting my day. It was a wonderful day when Dexcom G6 was approved without the requirement for daily calibrations.
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