Will my insurance, including Medicare, cover the cost of my FreeStyle Libre 3 sensor and reader?
For those that qualify*1, the FreeStyle Libre 3 system and reader are now eligible for Medicare coverage. 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.
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.