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Medicare Coverage Criteria Evolution

Medicare CGM coverage has evolved significantly, expanding access from intensive insulin users to broader diabetic populations.

Medicare Coverage Criteria Evolution

A History of Expanding Access

Medicare's CGM coverage has evolved dramatically over the past decade.

Key Milestones

Early Days

  • CGM initially not covered by Medicare
  • Considered "investigational" or not medically necessary

Initial Coverage (2017)

  • CGM covered for intensive insulin users only
  • Required 4+ daily insulin injections or pump use
  • Therapeutic CGM (real-time) covered under DME

2023 Update (LCD L33822)

Major expansion removing the "intensive" insulin requirement:

  • All insulin-treated diabetics now qualify
  • Non-insulin users with recurrent hypoglycemia qualify
  • Simplified documentation requirements

Current Requirements

To qualify for Medicare CGM coverage:

  1. Diabetes diagnosis
  2. One of:
    • Treatment with insulin, OR
    • Documented recurrent Level 2/3 hypoglycemia
  3. Physician prescription and oversight

Future Directions

Advocacy continues for:

  • Coverage of OTC CGMs
  • Reduced prior authorization requirements
  • Coverage for pre-diabetes prevention