CGM Policy Change Effective 4/16/2023

You can get receivers on places like eBay for 20 bucks, I bet the g7 ones are not as easy just yet, but you really don’t care if it works or not because you don’t intend to use it.
There is more than 1 way to knit a cat and you don’t have to lie either.
I mean I would never skin a cat, and I think lying about the receiver is less morally objectionable than skinning a cat, but still it was only a metaphor.

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So the Libre3 still is not covered. I stopped using the 2 because it was not accurate, sometime the readings were 25 percent different than my finger sticks. I was sticking my fingers so many times per day, and at my own expense, that I just disconnected.

Thank you for sharing.

I do. the bg meter covered by my health plan has been shown to read higher than actual for people with anemia. That means that correction boluses can easily be delivered when they are the last thing the person needs. Before doing my own “study” - more about that below, if I got an alert of a pending low (e.g. bg is 70 with downward arrow) I would do the obligatory fingerstick, and the bg meter would read close to 180. That’s a correction time. Turns out the CGM was right, I was going low and with that unnecessary correction I would crash.

I learned about the problem with anemic patients at an Endo CME. Took home the hard copies of the reports, purchased the highest rated bg meter and over a 2-month period (15+ fingersticks a day) saw that the CGM was closer (by far) to the most accurate meter. I can’t afford out of pocket test strips (15+ a day) so I dose based on my CGM. I haven’t had a serious low (where I needed help) in years now.

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Yes! This has really rubbed me the wrong way from the beginning when Dexcom got FDA approval and ran ads (in all fairness so did other CGM producers) that claimed “NO MORE FINGER STICKS” - as the kids say “what the fingerstick”! It was an absurd claim that could not possibly hold any merit but Medicare seems to have based their decision on that type of ad claim. Now if you use a CGM no more covered test strips.

Jim10 and Maire20’s descriptions of having to calibrate a newly inserted Dexcom sensor seems commonplace. You will have to calibrate using some sort of finger stick method device, most definitely less often than not using a CGM but still needed.

It is difficult to accept this and I guess that is why we see so much written about it here…

Good luck to us all,
-Steve

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Well it’s technically actually true . . You aren’t having to do MORE fingersticks.

. . . And you do get more data. . . .

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Thankfully I have private insurance besides Medicare.
Yes I still stick myself, after start up to verify calibration and when I have a sudden change in a 10-15 minute period.

RE: Medicare not covering test strips and lancets for CGM users

Since this topic was posted, I received refills of strips and lancets (In May) under Medicare. (I use a DexCom CGM) I was puzzled about the situation, so started Googling.

The cited document is an LCD (Local Coverage Determination). Per cms.gov "the term ‘local coverage determination’ means a determination by a fiscal intermediary or a carrier under Part A or Part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts’. These decisions are made by an MAC (Medical Administrative Contractor), which is a private health care insurer that has been awarded a defined geographic jurisdiction to process Medicare Part A and Part B medical or Durable Medical Equipment claims for Medicare Fee for Service Beneficiaries. The LCD cited regarding test strip coverage for CGM users lists the territories of American Samoa, Guam and Northern Mariana Islands and the states of HI, ID, IA ,KS, MO (“entire state”), MT, NE, NV, ND, OR, SD, UT, WA and WY. (My thought is that these territories and states are within the defined geographic jurisdiction of the MAC that issued this LCD, and are therefore governed by the LCD) (Yes, total alphabet soup. No carbs, just pure stress. [forgive the Diabetic Humor] )

I found all this info on Google and cannot vouch for its accuracy. Based on my personal experience, it’s true, at least for me (I live in WI). If you live in one of the states or territories cited on this LCD or have been denied test strips and lancets under Medicare in a state not listed on this LCD , it’d probably be a good idea to check directly with Medicare regarding coverage of test strips for CGM users. I also saw hits on Google regarding appealing a Medicare LCD. It appears that Medicare coverage is not the same for all 50 states and US territories. Who knew?

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