FAQ

When you eat your body turns food into sugars, or glucose. Your pancreas is supposed to release insulin which lowers your glucose. The Insulin’s job is to open your cells so glucose can enter, allowing your body to use the glucose for energy.

Controlling sugar levels is the main goal of treating diabetes. Insulin, exercise, and diet modification are the primary treatment options. Oral medications can also be prescribed, but when these measures fail to control elevated sugars, insulin treatment will be necessary.

Checking your glucose level regularly is essential for managing diabetes. Knowing what dose of insulin to take is complicated. The amount is based on factors that fluctuate every day, depending on food, exercise, stress, emotions, and general health. That is why a glucose meter and glucose test strips are important for frequent, accurate glucose monitoring.

Glucose (sugar) monitoring is the main tool you have to check on your diabetes control. This test tells you your glucose level at any one time. Keeping a log of your results is also vital, because it gives your healthcare provider a good picture of your body’s response to your diabetes care plan.

Continuous Glucose Monitoring (CGM) is a method of tracking glucose levels throughout the day and night.

CGM measures your glucose levels through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor.

A therapeutic CGM is one that meets the definition of durable medical equipment (DME) and is labeled by the Food & Drug Administration (FDA) for non-adjunctive use (i.e., it can be used to make treatment decisions without the need for a stand-alone home blood glucose monitor to confirm testing results). Note that not all products marketed as CGM devices are considered therapeutic CGMs by Medicare.

Medicare covers specific continuous glucose monitors (CGMs) referred to as “therapeutic CGMs”. Therapeutic CGMs are covered by Medicare if you meet the Medicare Coverage Criteria.

Medicare Coverage Criteria:

Therapeutic Continuous Glucose Monitoring (CGM) and related supplies are covered by Medicare when all of the following coverage criteria (1 – 5) are met:

1. The beneficiary has diabetes mellitus; and,
2. The beneficiary is insulin-treated with multiple (three or more) daily administrations of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
3. The beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of BGM or CGM testing results; and,
4. Within six (6) months prior to ordering the CGM the treating practioner has an in-person visit with the beneficiary to evaluate their diabetes control and determined that criteria (1-3) above are met; and,
5. Every six (6) months following the initial prescription of the CGM the treating practioner has an in-person visit with the beneficiary to assess adherence to their CGM regimen and diabetes treatment plan.