Medicare CGM Codes: Complete Reference Guide 2025

Understanding Medicare codes for CGM (Continuous Glucose Monitoring) systems doesn’t have to be complicated. As your trusted medicare codes cgm reference guide, we’ll walk you through everything you need to know about getting your CGM covered by Medicare in 2025.

This article provides general Medicare coverage information. Always verify specific coverage details with Medicare or call us at 727-831-3729 for personalized assistance.

Essential Medicare CGM Codes for 2025

Here are the key codes you’ll need for CGM coverage:

• E2103: Code for CGM system and receiver
• A4239: Monthly supplies (sensors and transmitters)
• 95249: Personal CGM setup and training
• 95251: CGM data interpretation and reporting

Keep this article handy when speaking with your healthcare provider or Medicare representative. Having these codes readily available can help streamline the coverage process.

Complete Medicare CGM Code Reference Table

Primary CGM Equipment Codes

Professional Service Codes

Diagnosis Codes (ICD-10)

Medicare Coverage Requirements for CGM

To qualify for CGM coverage under Medicare in 2025, you must meet these criteria:

• Have a diagnosis of Type 1 or Type 2 diabetes
• Complete CGM training (your prescription serves as proof)
• Be insulin-treated OR have documented problematic hypoglycemia
• Attend face-to-face or telehealth visits every 6 months

Important 2025 Update: Medicare no longer requires proof of testing blood sugar 3 times daily for CGM coverage.

Understanding Your CGM Medicare Benefits

Medicare Part B covers 80% of the approved amount for your CGM system and supplies. You’re responsible for the remaining 20% after meeting your Part B deductible ($240 in 2025).

Monthly Supply Costs (2025):

• Medicare Approved Amount: $250
• Medicare Pays: $200 (80%)
• Your Responsibility: $50 (20%)

How Different CGM Systems Use These Codes

FreeStyle Libre 3

• Initial Setup: E2103 (reader if not using phone)
• Monthly Supplies: A4239 (2 sensors)
• No separate transmitter code (built into sensor)

Dexcom G7

• Initial Setup: E2103 (receiver if not using phone)
• Monthly Supplies: A4239 (3 sensors)
• Quarterly: A4238 (transmitter replacement)

Guardian Connect

• Initial Setup: E2103 (required receiver)
• Monthly Supplies: A4239 (sensors)
• Annual: A4238 (transmitter replacement)

Steps to Secure Medicare CGM Coverage

1. Get a prescription from your doctor documenting medical necessity
2. Ensure your doctor includes appropriate diagnosis codes
3. Choose a Medicare-enrolled supplier
4. Schedule required follow-up visits every 6 months

Documentation Your Doctor Must Include

Prescription Requirements:

• Patient name and Medicare number
• Diagnosis codes (E10.x or E11.x)
• Medical necessity statement
• CGM brand/model prescribed
• Frequency of supply needs

Medical Records Must Show:

• Diabetes diagnosis confirmation
• Treatment plan (insulin or hypoglycemia)
• Recent A1C or glucose logs
• Face-to-face visit documentation
• Patient willing to use CGM

Common Coverage Issues and Solutions

If you encounter coverage denials, check for these common issues:

• Missing or incorrect diagnosis codes
• Incomplete documentation of medical necessity
• Lapsed face-to-face visits
• Non-Medicare-enrolled supplier

Need help resolving coverage issues? Call our CGM Medicare specialists at 727-831-3729 for personalized assistance.

Medicare Advantage Plan Codes

Medicare Advantage plans use the same codes but may require:

• Prior authorization forms
• Specific supplier networks
• Additional documentation
• Different cost-sharing structures

Understanding Your Medicare Summary Notice

When reviewing your Medicare Summary Notice, look for:

Approved Services:

• E2103 – CGM Device (one-time)
• A4239 – CGM Supplies (monthly)

Service Dates:

• Should match your supply deliveries
• Monthly recurring for supplies

Amount Charged vs. Approved:

• Medicare-approved amounts are standardized
• You pay 20% of approved amount only

Supplier Billing Best Practices

What Your Supplier Should Do:

• Use correct HCPCS codes
• Include proper modifiers
• Submit clean claims
• Maintain documentation

Red Flags to Watch For:

• Billing for non-covered items
• Incorrect quantities
• Upcoding services
• Duplicate billing

Appeals and Denials

If Your Claim is Denied:

Check the denial code:

• CO-50: Non-covered service
• CO-97: Payment included in allowance
• PR-96: Non-covered charge
• PR-119: Benefit maximum reached

Common denial reasons:

• Wrong diagnosis code used
• Missing modifier codes
• Documentation incomplete
• Supplier not enrolled

Frequently Asked Questions

Which CGM systems are covered by Medicare?

Medicare covers therapeutic CGM systems from Dexcom and FreeStyle Libre that are approved for making treatment decisions without confirmatory finger sticks.

How often can I get new CGM supplies?

Medicare covers:

• Sensors: Every 30 days
• Transmitters: Every 90 days
• Receivers: Every 5 years

What if I have Medicare Advantage?

Medicare Advantage plans must provide at least the same coverage as Original Medicare, but may have different preferred suppliers or prior authorization requirements.

Do codes differ by state?

No, Medicare HCPCS codes are national. However, Local Coverage Determinations (LCDs) may vary by Medicare Administrative Contractor (MAC) region.

Tips for Healthcare Providers

When Prescribing CGMs:

1. Use specific HCPCS codes on prescriptions
2. Include all required diagnosis codes
3. Document medical necessity clearly
4. Specify brand/model when applicable

Documentation Checklist:

☐ Diabetes diagnosis (E10.x or E11.x)
☐ Treatment plan documentation
☐ Hypoglycemia history (if applicable)
☐ Patient education completed
☐ Follow-up schedule established

Code Updates and Changes

Stay Informed:

• Check CMS updates quarterly
• Review LCD changes
• Monitor MAC bulletins
• Subscribe to supplier updates

Recent Changes (2025):

• Removed 3x daily testing requirement
• Expanded hypoglycemia criteria
• Added telehealth visit options
• Simplified documentation requirements

Working with Your Supplier

Information to Provide:

• Medicare number
• Prescription with codes
• Doctor’s NPI number
• Diagnosis information
• Previous CGM use (if any)

Questions to Ask:

• “Do you accept Medicare assignment?”
• “Which codes will you bill?”
• “What’s my estimated cost?”
• “How do you handle denials?”

Your Quick Reference Card

Print and Keep This Information:

Essential Codes:

• CGM Device: E2103
• Monthly Supplies: A4239
• Transmitter: A4238

Key Requirements:

• Diabetes diagnosis
• Doctor visit every 6 months
• Medicare Part B coverage

Your Costs:

• 20% of Medicare-approved amount
• After $240 deductible (2025)

Additional Resources

Medicare Resources:

• Medicare.gov/coverage/cgm
• 1-800-MEDICARE
• MyMedicare.gov account

Professional Resources:

• CMS.gov HCPCS database
• MAC LCD databases
• DMEPOS supplier directory

Take Action Today

Ready to check your CGM coverage? Our team can help:

Call 727-831-3729 for personalized assistance
Use our online Coverage Checker tool
Download our free Medicare CGM Guide

Last updated: January 2025

Need Expert Help with Medicare CGM Codes?

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