Does Medicare Part B cover Continuous Glucose Monitoring (CGM) supplies?

Medicare Coverage for Continuous Glucose Monitoring (CGM) Supplies

Yes, Medicare Part B does cover CGM supplies for eligible beneficiaries who meet specific coverage criteria, including those who require intensive insulin management or have a history of problematic hypoglycemia.

Coverage Criteria for CGM Under Medicare Part B

Medicare Part B covers CGM devices and supplies for beneficiaries who:

1. Have diabetes requiring intensive insulin management, including:

   • Patients with Type 1 diabetes
   • Patients with Type 2 diabetes on multiple daily injections (MDI) or insulin pump therapy 1

2. Have specific clinical needs, such as:

   • Unexplainable severe hypoglycemia
   • Recurrent hypoglycemia or asymptomatic hypoglycemia
   • Nocturnal hypoglycemia
   • Hypoglycemia unawareness 1, 2

Types of CGM Covered

Medicare Part B covers two main categories of CGM devices:

1. Real-time CGM: Systems that continuously measure glucose levels and provide automated alarms/alerts at specific glucose levels 1

2. Intermittently scanned CGM: Systems that measure glucose continuously but only display values when scanned by a reader or smartphone 1

Coverage Requirements

For Medicare to cover CGM supplies, the following conditions must be met:

• Physician documentation confirming diabetes diagnosis and need for intensive insulin management
• Prescription specifying the CGM device and supplies needed (e.g., "Freestyle Libre sensor, apply one sensor every 14 days to back of upper arm, scan as needed for glucose monitoring") 2
• Regular follow-up with healthcare provider to review CGM data and adjust treatment as needed

Supplies Covered

Medicare Part B covers:

• CGM sensors (typically replaced every 7-14 days depending on the device)
• Transmitters (replaced according to manufacturer specifications)
• Receivers (if not using a compatible smartphone)

Important Considerations

• Therapeutic CGM: Medicare specifically covers devices that are FDA-approved for making treatment decisions without confirmatory fingerstick testing 1
• Hospital use: For hospitalized patients with diabetes, CGM use can be continued during hospitalization when clinically appropriate, with confirmatory point-of-care blood glucose measurements 1
• Replacement schedule: Adherence to the recommended replacement schedule is crucial for maintaining optimal accuracy and device performance 2

Common Pitfalls and How to Avoid Them

1. Incorrect documentation: Ensure proper documentation of medical necessity, including specific indications such as hypoglycemia unawareness or need for intensive insulin management.

2. Wrong device type: Medicare only covers therapeutic CGM devices approved for making treatment decisions without fingerstick confirmation.

3. Improper billing: DME suppliers must follow Medicare billing requirements carefully to avoid audits and payment denials 3.

4. Patient selection: Not all patients with diabetes qualify for Medicare coverage of CGM. Coverage is primarily for those requiring intensive insulin management or with problematic hypoglycemia.

CGM technology has been demonstrated to improve clinical outcomes by reducing risks of hypoglycemia and hyperglycemia, decreasing glycemic variability, and improving quality of life for appropriate patient populations 4. For Medicare beneficiaries who qualify, having access to this technology can significantly improve their diabetes management and quality of life.