For those that qualify*1, the FreeStyle Libre 3 system and reader are now eligible for Medicare reimbursement. For commercial coverage, please contact your insurance company regarding cost and coverage of the FreeStyle Libre 3 system.
Medicare CGM Coverage Criteria:
A. The beneficiary has diabetes mellitus; and,
B. The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the CGM prescribed as evidenced by providing a prescription; and,
C. The CGM is prescribed in accordance with its FDA indications for use; and,
D. The beneficiary for whom a CGM is being prescribed, to improve glycemic control, meets at least one of the criteria below:
- The beneficiary is insulin-treated; or,
- The beneficiary has a history of problematic hypoglycemia with documentation of at least one of the following (see the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS section of the LCD-related Policy Article (A52464)):
-- Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or,
-- A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia
E. Within six (6) months prior to ordering the CGM, the treating practitioner has an in-person or Medicare-approved telehealth visit with the beneficiary to evaluate their diabetes control and determined that criteria (1)-(4) above are met.
*Patients must meet Medicare eligibility coverage criteria.
1 Centers for Medicare & Medicaid Services, Local Coverage Determination (LCD) L33822, Glucose Monitors, https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33822.
Medicare coverage is available for FreeStyle Libre systems if their respective readers are used to review glucose data on some days every month. Medicare and other third party payor criteria apply.
Abbott provides this information as a courtesy; it is subject to change and interpretation. The customer is ultimately responsible for determining the appropriate codes, coverage, and payment policies for individual patients. Abbott does not guarantee third party coverage or payment for our products or reimburse customers for claims that are denied by third party payors.