Medicare - Help!

I’ve been using the FreeStyle Libre for about a month now. But I’ve been paying out-of-pocket. So, I intend to apply to Medicare for reimbursement. This is where things get confusing.

My endo’s office tells me what is required. This is totally based on their Dexcom experience, however. I am their first patient using the FreeStyle Libre. However, the criteria for Medicare coverage seems to apply to ALL CGMs that are suitable for dosing. There are four criteria:
1 Has diabetes mellitus
2 Has been using a BGM and testing 4 or more tests per day
3 Insulin treated with 3 or more daily injections (or pump) and
4 Frequent insulin adjustments are required based on BGM or CGM testing results.

In addition, the applicant must have an in-person visit the practitioner to determine the four criteria have been met.

Also, every six months, the applicant must have an in-person visit to assess adherence to their CGM regimen and diabetes treatment plan.

All this seems pretty clear to me. However I am being told by the endo’s office that Medicare is asking them for blood glucose meter readings according to requirement 2, even AFTER the initial prescription! This makes no sense, of course, and the endo office agrees. Their answer: we’re dealing with the government!

So my question (finally!) is this: Do those of you who have been on Medicare coverage of Dexcom face any requirement for ongoing 4X BGM readings (rule 2,) exclusive of calibration requirements?

A second question is this: Even if this rule 2 doesn’t apply, certain readings on the FreeStyle call for a backup test on a BGM (e.g. rapidly falling readings) How many strips should I expect to be covered for this purpose?

I am on Medicare and yes they periodically require records from my doctor’s office showing my testing and all the blood work yada yada yada. I’ve been getting 1400 strips every 90 days but I’ve asked him to reduce that to 900 because my Dexcom allows me to forgo most of my finger sticks nowadays. Getting what you actually need is all about how good of a doctor you have. Some doctors don’t care enough about their patients to send in all the appropriate information and use their powers of persuasion. In other words they have to know exactly what to say in order to get coverage for the patient when the patient doesn’t quite meet every single nitpicky requirement.

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