Previous requirements for CGM coverage
Before the policy change, Medicare required patients to:
- Use a fingerstick test four times a day to prove diabetes management status.
- Attend in-person clinical visits with their doctor.
These rules were both time-consuming and cumbersome, creating hurdles for many.
Challenges of previous rules
The old requirements caused several issues for patients and providers:
- No medical benefit: Rodolfo Galindo, MD, FACE, an endocrinologist, noted fingerstick benchmarks lacked scientific evidence of HbA1c improvements.
- Physical limitations: Patients with reduced dexterity often found frequent fingersticks impractical.
- Financial burden: Test strips cost over $100 a month, but Medicare only covered three strips daily—leaving patients to cover extra costs.
- Many Medicare beneficiaries already live below the federal poverty line.
- Bureaucracy for providers: Healthcare professionals had to navigate in-person visits, lab tests, fingerstick documentation and excessive paperwork.
Medicare’s policy change
The revised policy simplifies access to CGMs. Medicare beneficiaries no longer need to:
- Use fingersticks four times a day.
- Attend in-person visits to qualify for coverage.
CGMs under Medicare coverage
CGMs are covered as durable medical equipment (DME) under Medicare’s Part B benefit.
Patients still need to meet eligibility requirements, but the updated policy removes unnecessary barriers, making CGMs more accessible, especially to low-income populations.
Benefits of CGM use
CGMs provide many proven advantages, including:
- Lower HbA1c levels: Better long-term blood sugar management.
- More time in range: Helps avoid spikes and dips in blood sugar.
- Fewer hospitalizations: Reduced risk of diabetes-related emergencies.
Why this change matters
For healthcare providers, recommending CGMs becomes simpler without excessive red tape.
For patients, the change removes financial and logistical barriers, making life-saving diabetes technology more accessible.
Moving forward
This policy revision ensures people with diabetes can access CGMs without burdensome rules, improving their quality of life and overall health.
Eliminating lab tests and in-person visits means fewer barriers to cutting-edge diabetes management tools.
Medicare’s updated LCD policy represents a step forward in making diabetes care more equitable and accessible for all.
