Medicare Criteria for CGM
According to the U.S. Centers for Medicare & Medicaid Services (CMS), if you have Type 1 or Type 2 diabetes, intensively manage your insulin, and meet all of the following eligibility criteria, you can get a Therapeutic CGM covered by Medicare.
Does Medicare cover Therapeutic Continuous Glucose Monitors (CGMs)?
Yes! Continuous Glucose Monitoring Systems are covered by Medicare for patients who meet the Medicare coverage criteria. Medicare patients who have either type 1 or type 2 diabetes and manage their insulin therapy may be able to obtain a therapeutic CGM if the following Medicare coverage criteria is met:
- The patient has diabetes;
- The patient uses three or more daily administrations of insulin (MDI) or an insulin pump;
- The patient’s insulin treatment regimen requires frequent adjustments based on BGM or CGM testing results;
- Within six months prior to ordering the CGM, the patient had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria have been met; and
- To remain eligible, the patient must have an in-person visit with his/her treating practitioner every six months to evaluate adherence to their CGM therapy and diabetes treatment plan.
- For a full description of coverage criteria, click here.
DO YOU QUALIFY?ENROLL FOR YOUR CGM TODAY!
Medicare does not cover CGM supplies that are used ONLY with a smartphone or other mobile device. Therefore, you must use a receiver to view your glucose data.
Coverage of Continuous Glucose Monitor system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. There is no Medicare benefit for supplies used with equipment that is not classified as DME.
However, coverage of CGM system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. If a beneficiary intends to never use a receiver classified as DME as the display device, the supplies and accessories are not covered by Medicare.
Do you qualify? Not sure if you qualify? No problem! Let our team of diabetes care advisors assist you through the process. Start by simply filling out this enrollment form. Our team will review your details and reach out to you directly to start the process.
The information contained within is intended to be general information only – not a form of advice on billing practices. It is not intended to serve as medical, health, legal or financial advice or substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant, or financial advisor. Providers should always verify billing codes, plan coverage, and reimbursement with patient’s insurance. Visit the U.S. Centers for Medicare & Medicaid Services (CMS) for more detailed information.