Medicare Coverage For Continuous Glucose Monitoring System

The centers for medicare and medicaid services cms will cover therapeutic continuous glucose monitoring cgm and have set the criteria that must be met.

Medicare coverage for continuous glucose monitoring system.

Medicare part b medical insurance covers blood sugar monitors as durable medical equipment dme that your doctor prescribes for use in your home. Medicare does not generally cover continuous glucose monitoring which according to the nih involves a sensor inserted under your skin for several days to a week. Medicare covers therapeutic continuous glucose monitors cgms and related supplies instead of blood sugar monitors for making diabetes treatment decisions like changes in diet and insulin dosage. Cms announced the criteria decision march 23 following their january ruling about granting coverage for cgm.

The coverage includes two cgm systems. There are two fda approved systems available that offer different strengths that appeal to different patient situations. If you use insulin and require frequent adjustments to your insulin regimen dosage a cgm may be covered if your doctor determines that you meet all of the requirements for medicare coverage. Medicare covers the treatment of type 1 or type 2 diabetes that involves intensive insulin therapy with multiple injections or the use of the pump on a daily basis.

All continuous glucose monitors cgms may soon be covered by medicare if a new proposed federal rule is approved and takes effect. If your health care provider recommends a different way to monitor your blood sugar other than the finger stick glucose monitor you might want to check with medicare to see whether it s covered. Medicare has begun covering continuous glucose monitoring systems which is leading to more seniors using systems shown to improve glycemic control. Your costs in original medicare if your supplier accepts assignment you pay 20 of the medicare approved amount and the part b deductible applies.

In addition medicare ruled last year that therapeutic cgm systems those that provide information that can be used to make treatment decisions could be covered as necessary durable medical equipment the same category of coverage that includes blood glucose meters because they meet all of medicare s coverage criteria. In the past it has not been covered. Abbott s freestyle libre that provides real time monitoring of blood glucose levels and dexcom s g5.