Medicare Criteria for Therapeutic 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.

Eligibility Criteria

  • 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.

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