Continuous Glucose Monitors, or CGMs, have pushed diabetes management to a whole other level as they give the patient information on glucose in real-time to have more control over the condition while making it less inconvenient. It is for this reason that most patients with such advanced technology look to Medicare benefits for relief from the associated costs. Therefore, one must come to know of specific CGM Medicare requirements for these individuals who wish to avail themselves of this life-enhancing tool and find relief in the costs that may be incurred.
What Are the CGM Medicare Requirements?
Any Medicare-covered use of a Continuous Glucose Monitor must meet eligibility criteria. There is no automatic qualification for Medicare coverage for the use of Continuous Glucose Monitors if you have diabetes. Knowing these Medicare requirements can help you determine if you’re qualified and guide you through the process.
Medicare Part B does cover a CGM, but only if the individual has diabetes and is insulin-dependent. That is, they need injections of insulin at least daily or use an insulin pump. They must also have proof that they test their blood sugars frequently, more than four times a day. This frequent testing is evidence of a need for continuous glucose tracking.
The other requirement is that a prescription has to come from a healthcare professional. The prescription has to be definitely marked as medically necessary for CGM. If other treatments need to be more, your physician ought to be prepared to document how CGM will enhance the way you manage glucose levels.
CGM Types Covered by Medicare
Medicare will only cover a few specified types of CGMs. The CGMs that qualify under Medicare are therapeutic examples. The patient would be able to be treated directly through CGM readings for the Dexcom G6 and the Freestyle Libre systems without needing to confirm the results through a finger-stick test.
Non-therapeutic CGMs validated using traditional testing methodologies do not meet the eligibility criteria for CGM Medicare coverage. Therefore, it is essential to establish that the device under consideration is on the list of recognized devices so that the benefits can be availed of.
How to Apply for CGM Coverage Through Medicare
Meeting the Medicare requirements of CGM is only the first step. Your prescription and all relevant medical documentation for the device will be submitted to start the process. The physician’s supporting documentation is the most crucial tool in getting Medicare approval to show the medical necessity of using the device to manage diabetes.
Patients should also check whether their selected CGM provider is Medicare-approved. Otherwise, ordering from a supplier who does not accept Medicare may put one into an out-of-pocket expense.
Final Thoughts
CGMs provide significant assistance to diabetics, and Medicare can be configured to serve many. The information you possess regarding CGM Medicare requirements will make the process much easier and increase your chances of getting approved. Being eligible, choosing from among the Medicare-approved CGMs, and getting documented appropriately are crucial in getting you your much-needed device.
