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If you are curious whether you qualify for CGM, read on to learn more.

Dexcom CGM monitorTherapeutic CGMs and related supplies are covered by Medicare when all of the following coverage criteria (1-6) are met:

  1. The beneficiary has diabetes mellitus; and,

  2. The beneficiary has been using a BGM and performing frequent (four or more times a day) testing; and,

  3. The beneficiary is insulin-treated with multiple (three or more) daily injections of insulin or a Medicare-covered continuous subcutaneous insulin infusion (CSII) pump; and,

  4. The beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of BGM or CGM testing results; and,

  5. Within six (6) months prior to ordering the CGM, the treating practitioner has an in-person visit with the beneficiary to evaluate their diabetes control and determined that criteria (1-4) above are met; and,

  6. Every six (6) months following the initial prescription of the CGM, the treating practitioner has an in-person visit with the beneficiary to assess adherence to their CGM regimen and diabetes treatment plan.

When a therapeutic CGM is covered, the related supply allowance for sensors, transmitters, batteries, and calibration supplies are also covered.

Therapeutic CGM devices replace a standard home blood glucose monitor (HCPCS codes E0607, E2100, E2101) and related supplies (HCPCS codes A4233-A4236, A4244-A4247, A4250, A4253, A4255-A4259). Claims for a BGM and related supplies, billed in addition to an approved CGM device (code K0554) and associated supply allowance (code K0553), will be denied. 

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