Significant progress has been made for coverage of continuous glucose monitoring (CGM) with both commercial health insurers and government-sponsored plans. Many of the reimbursement challenges experienced by the early-adopters of CGM no longer exist and today’s reimbursement environment has become more favorable.
Commercial Health Coverage
Coverage of CGM for type 1 diabetes is offered for 98% of commercially insured members, and many plans also provide coverage for members with insulin-using type 2 diabetes.* Below you will find reimbursement information for commercial coverage, including the CGM coding reference sheet and sample plans of regional payers for personal CGM.
Medicare Coverage for CGM
Medicare now provides coverage for therapeutic CGM systems (those approved for use in making diabetes treatment decisions).The Dexcom G5® CGM System is the first therapeutic CGM system covered as a Medicare benefit.
*Internal data on file.
Note: The beneficiary may NOT use their phone either as a primary receiver or, as a secondary device and still be eligible for Therapeutic CGM.