Continuous Glucose Monitoring (CGM)

What is Continuous Glucose Monitoring (CGM)?

Continuous Glucose Monitoring (CGM) is an innovative sensor-based technology that tracks blood glucose levels continuously by measuring glucose in the interstitial fluid. Designed for convenience and accuracy, CGM provides real-time data, capturing glucose levels every few minutes, 24 hours a day.

  • Goodbye to Finger Sticks: Unlike traditional methods, CGM eliminates the need for routine finger sticks to check blood glucose levels.
  • Seamless Monitoring: The sensor tracks how glucose levels change after meals, during exercise, or overnight, offering valuable insights into patterns and trends.
  • Discrete and Durable: Worn comfortably on the body, CGM sensors are water-resistant, allowing you to shower, swim, and perform daily activities without interruption. Depending on the manufacturer, sensors are replaced every 10–14 days.
  • Integrated Technology: CGMs can be paired with insulin pumps for a more streamlined diabetes management approach.
  • Wireless Data Transmission: Glucose readings are sent wirelessly to a receiver or smartphone app, making it easy to monitor your levels anytime, anywhere.

Key Benefits of CGM

  1. No More Finger Sticks: Say goodbye to the hassle and discomfort of frequent finger pricks to measure blood glucose levels.
  2. Hypoglycemia Alerts: CGM devices can alert you to low blood sugar (hypoglycemia) before symptoms occur, especially helpful during sleep or high-risk activities.
  3. Insights for Better Control: Learn how your body responds to meals, exercise, and overnight glucose patterns, empowering you to make adjustments that keep you in the "control zone" longer.
  4. Shared Data: Easily share your glucose readings with your healthcare provider or family members for better support and treatment adjustments.

Who is Covered?

Coverage for a Continuous Glucose Monitoring (CGM) system depends on your specific health insurance plan. It's essential to check with your provider to understand any deductibles or co-pays that may apply.

To qualify for CGM coverage, most plans require the following:

  1. Diabetes Diagnosis: The patient must have a diagnosis of diabetes and be insulin-dependent, whether Type 1, Type 2, or gestational diabetes (Type 3).
  2. Insulin Use and Monitoring: The patient must administer insulin at least three times per day and have a documented history of manually testing blood glucose at least four times daily for a minimum of two months.
  3. Medical Evaluation: An initial "face-to-face" examination with the prescribing physician is required. Follow-up evaluations must be conducted every six months (or as specified by your health plan). The physician must confirm that the patient has received proper education on CGM use and has an established treatment plan that incorporates CGM technology.
  4. Uncontrolled HbA1C: The patient's HbA1C level must be above 7%, indicating difficulty maintaining adequate glucose control.
  5. Hypoglycemia History: The patient must have experienced:
    • At least three episodes of blood glucose levels below 54 mg/dL without symptoms, OR
    • At least one episode of hypoglycemia below 54 mg/dL with symptoms. Symptoms may include mental status changes, brain fog, lightheadedness, dizziness, fatigue, sweating, syncope, pre-syncope, or palpitations.

Understanding these requirements and working closely with your healthcare provider will help ensure a smooth approval process for CGM coverage.

 



What's included?

  • Medicare Guidelines for Continuous Glucose Monitoring (CGM) Supplies

    Medicare generally covers a 90-day supply of CGM supplies, which includes 10 sensors and 1 transmitter. A receiver, which is required to read the transmitted glucose levels, is typically covered by Medicare once every 1-5 years. Alternatively, patients who use a compatible smartphone may utilize it as a receiver, potentially eliminating the need for a separate device. The warranty for a CGM receiver is generally 4 years.

    It is important to note that Medicare does not cover both a manual glucometer and a CGM simultaneously. Patients must choose one method for glucose monitoring to align with Medicare coverage guidelines. For questions about coverage and eligibility, consult your healthcare provider or Medicare representative to ensure compliance and optimize your benefits.