FAQs on CGM Coverage Criteria Changes in Medicare

On March 2, 2023, Centers for Medicare and Medicaid Services (CMS) announced expanded Continuous Glucose Monitor (CGM) coverage. Find answers to some of the most frequently asked questions about this change.

Changes to Medicare coverage will increase eligibility for continuous glucose monitoring devices, also known as CGMs. What are the new eligibility requirements?

If you or your patients have Medicare, new changes allow greater access to a CGM devices. Medicare beneficiaries with diabetes may be eligible if they:

1. Have diabetes
   and
2. Your health care provider concludes you (or your caregiver) have sufficient training using the CGM prescribed as evidenced by providing a prescription
   and
3. The CGM is prescribed in accordance with its Food and Drug Administration (FDA) indications for use
   and
4. The beneficiary for whom a CGM is being prescribed to improve glycemic management meets at least one of the criteria below:
   A. Is insulin-treated
   or
   B. Has a history of problematic hypoglycemia (low blood glucose, also called low blood sugar) with documentation of at least one of the following:
   —Recurrent (more than one) level 2 hypoglycemic events (glucose or
   —A history of one level 3 hypoglycemic event (glucose and
5. Within six months prior to ordering the CGM, the treating practitioner has an in-person or Medicare-approved telehealth visit with you to evaluate your diabetes control and determine that criteria one through four above are being met.