Medicare Criteria for Therapeutic CGMs

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.

medicare checklist - EHCS

Medicare Criteria for Therapeutic CGMs

  • You have diabetes mellitus
  • You have been using a home blood glucose monitor (BGM) and performing frequent (4+ times a day) BGM testing
  • You are insulin treated with 3+ daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump
  • Your insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results
  • Within the past 6 months, you have seen your doctor to evaluate your diabetes control and determine that the above requirements have been met

Please note that if you receive a Therapeutic CGM paid for by Medicare, you are required to have an in-person visit with your doctor to assess the adherence to your CGM regimen and diabetes treatment plan.

Do you qualify? Apply for your CGM Today! Not sure if you qualify, no problem, let our team assist you through the process.

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