Medicare Coverage for Continuous Glucose Monitoring System and Prescribing Requirements

Medicare Coverage Requirements for Continuous Glucose Monitoring System 

Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy may be able to obtain reimbursement if the following Medicare coverage criteria are met:

• The patient has diabetes;
• The patient is insulin-treated with three or more daily administrations of insulin or a continuous subcutaneous insulin infusion (CSII) pump;
• The patient's insulin treatment regimen requires frequent adjustments based on BGM or CGM testing results;
• Within six months prior to ordering the CGM, the patient had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria have been met; and
• Every six months following the initial prescription of the CGM, the patient has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.

In order to qualify for Medicare coverage of your Dexcom G6 supplies, Medicare requires that you have a receiver that is compatible with Dexcom G6 Continuous Glucose Monitor and that you use that receiver with your supplies, even if you also use a compatible smart device.  Medicare does not cover Dexcom G6 supplies that are only used with a smartphone or other mobile device.

Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid services website.

List of Medicare Distributors

A patient must call their plan to confirm that the distributor is in their network.