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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.
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
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
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).
- Medicare Approved Amount: $250
- Medicare Pays: $200 (80%)
- Your Responsibility: $50 (20%)
Steps to Secure Medicare CGM Coverage
- Get a prescription from your doctor documenting medical necessity
- Ensure your doctor includes appropriate diagnosis codes
- Choose a Medicare-enrolled supplier
- Schedule required follow-up visits every 6 months
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
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.
- Call 888-649-5705 for personalized assistance
- Use our online Coverage Checker tool
- Download our free Medicare CGM Guide
Last updated: January 2025
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