November 9, 2018 - Revised April 2026

The Comprehensive Error Rate Testing (CERT) program has noted a high claim error rate for glucose monitors. The following information is provided to assist you in reducing these types of errors.

Medicare will consider coverage of a glucose monitor and related supplies when your patient's medical record shows they have diabetes and you have determined that the patient or a caregiver is sufficiently trained to use the prescribed device appropriately. (Reference: CMS Internet Only Manual (IOM), Publication 100-03, National Coverage Determinations Manual, Chapter 1, Section 40.2.)

Order Requirements

The Standard Written Order (SWO) for the glucose monitor and supplies must include the following:

• Patient name or Medicare Beneficiary Identifier (MBI)
• Order date
• General description of the item (may be a narrative description, a HCPCS code, HCPCS code narrative, or brand name/model number)
• For equipment - In addition to the description of the base item, the SWO may include all concurrently ordered options, accessories or additional features that are separately billed or require an upgraded code (List each separately).
• For supplies - In addition to the description of the base item, the DMEPOS order/prescription may include all concurrently ordered supplies that are separately billed (List each separately)
• Quantity to be dispensed, if applicable
• Treating practitioner name or National Provider Identifier (NPI)
• Treating practitioner's signature

Testing Requirements

Medicare will consider coverage for the diabetic testing regimen as outlined in Local Coverage Determination (LCD) L33822:

For your patients that require additional testing per day, or the quantities of supplies ordered exceed Medicare's standard utilization parameters, there are some additional documentation requirements that must be met. These are outlined in the LCD:

1. Basic requirements have been met
• The patient has diabetes as indicated in their medical record and
• You have ordered a blood glucose monitor and/or related testing supplies, and the patient and/or caregiver have been appropriately trained; and,
2. Within six (6) months prior to ordering quantities of strips and lancets that exceed the utilization guidelines, the treating practitioner had an appropriate visit with the beneficiary to evaluate their diabetes control, and their need for the specific quantity of supplies that exceed the usual utilization amounts described above; and,
3. Every six (6) months, for continued dispensing of quantities of testing supplies that exceed the usual utilization amounts, the treating practitioner must verify adherence to the high utilization testing regimen. The medical record should contain clinical rationale for excess testing as well as any changes to the diabetic treatment plan.

Continuous Glucose Monitors (CGMs)

Therapeutic CGMs and related supplies are covered by Medicare when all coverage criteria (1-5) are met:

1. Your patient has diabetes mellitus; and
2. You have concluded that your patient or their caregiver has sufficient training using the CGM prescribed as evidenced by providing a prescription; and
3. The CGM is prescribed in accordance with its FDA indications for use; and,
4. The patient for whom a CGM is being prescribed, to improve glycemic control meets at least one of the criteria:
1. The patient is insulin treated, or
2. The patient has a history of problematic hypoglycemia with documentation of least one of the following:
   • Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persists despite multiple (more than one) attempts to adjust medications(s) and/or modify the diabetes treatment plan; OR
   • A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring 3rd party assistance for treatment of hypoglycemia;
5. Within six (6) months prior to ordering the CGM, you have had an in-person or Medicare-approved telehealth visit with the patient to evaluate their diabetes control and determine criteria (1-4) have been met

For CGM continued coverage, every six (6) months following the initial prescription of the CGM, you have an in-person visit or Medicare-approved telehealth visit with your patient to assess adherence to their CGM regimen and diabetes treatment plan.

For the in-person or Medicare-approved telehealth treating practitioner visit that is required as part of the ongoing provision of a CGM, there must be sufficient information in the patient's medical record to determine that the patient continues to adhere to their diabetes treatment regimen and use of the CGM device.

For coverage and limitations of these supplies review Local Coverage Determination (LCD) L33822, Policy Article A52464 and Standard Documentation Requirements Article A55426.