Does Medicare Cover a CGM? The Rules in Plain Language

What you need to qualify

Medicare.gov says your doctor or other provider must order the CGM and that you must meet two conditions: you take insulin or have a history of problems with low blood sugar, and you or your caregiver have had enough training to use it as directed. The CMS policy (Local Coverage Determination L33822) spells out five requirements, all of which must be met:

1. You have diabetes mellitus.
2. Your treating practitioner has concluded you or your caregiver is sufficiently trained, shown by a prescription.
3. The CGM is prescribed according to its FDA indications for use.
4. To improve glycemic control, you are insulin-treated or have a history of problematic hypoglycemia, documented by at least one qualifying event, such as more than one level 2 low or one level 3 low that needed another person’s help.
5. Within six months before the order, you had an in-person or Medicare-approved telehealth visit that evaluated your diabetes control and confirmed the above.

What changed

The policy no longer requires multiple (three or more) daily insulin administrations. CMS removed it in revision R12 (April 16, 2023). The policy also says people who take only oral medication for diabetes are not insulin-treated, so they qualify only through problematic low blood sugar.

Keeping coverage

Every six months after the first prescription, your practitioner must hold an in-person or Medicare-approved telehealth visit documenting that you are using the CGM and following your treatment plan.

What you pay

The CGM is listed as covered by Part B and as durable medical equipment. After you meet the Part B deductible you pay 20% of the Medicare-approved amount, if the supplier accepts assignment. Medicare.gov advises confirming that your doctor and DME supplier are enrolled in Medicare. Use the supply cost calculator to add your own figures.

Brand notes

• FreeStyle Libre 3 and 3 Plus: Abbott states the sensor and reader are eligible for Medicare reimbursement for people who qualify, and does not guarantee payment. See the Libre 3 Plus page.
• Eversense 365: its page says Medicare coverage is “not a guarantee” and a prescription is required. See Eversense.
• Dexcom G7: follows the same rule. See Dexcom G7.
• Over-the-counter sensors (Stelo, Lingo): we found no Medicare statement that Part B pays. See over-the-counter CGMs.

Medicare also covers test strips and lancets, and caps insulin at $35 a month per covered product. Medicare Advantage plans may have their own rules, so ask your plan.

Information only, not medical advice. Your care team may set different targets for you, and only a lab test ordered by a clinician can diagnose diabetes or prediabetes. See our medical disclaimer.