Medicare Part B CGM Requirements: Do You Qualify in 2025?

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Last updated: January 2025

Understanding Medicare Part B CGM requirements doesn’t have to be complicated. If you’re a senior with diabetes wondering if you qualify for a Continuous Glucose Monitor (CGM) through Medicare in 2025, you’re in the right place. We’ll walk you through the updated requirements step-by-step.

This article provides general information about Medicare coverage and is not medical advice. Always consult your healthcare provider and verify coverage with Medicare directly.

Do You Meet Medicare Part B CGM Requirements in 2025?

Medicare has simplified CGM coverage requirements for 2025, making it easier for many seniors to qualify. Here’s what you need to know:

Basic Qualification Checklist:

  • You have Medicare Part B coverage
  • You have been diagnosed with Type 1 or Type 2 diabetes
  • You meet with your doctor in person or via telehealth at least every 6 months
  • You or your caregiver can operate the CGM device
💡 Important Update: As of 2025, Medicare no longer requires you to test your blood sugar 3 times daily to qualify for CGM coverage.

Treatment Requirements – You Must Meet ONE of These:

To qualify for CGM coverage, you must either:

  • Use insulin for diabetes management (any frequency), OR
  • Have documented problematic hypoglycemia:
    • 2 or more Level-2 episodes (blood sugar below 54 mg/dL), OR
    • 1 or more Level-3 episode (requiring assistance from others)

Step-by-Step Guide to Getting CGM Coverage

Follow these steps to secure your Medicare CGM coverage:

  1. Schedule a doctor’s appointment (in-person or telehealth)
  2. Bring documentation of your diabetes management
  3. Discuss CGM options with your healthcare provider
  4. Get proper documentation of qualifying conditions
  5. Obtain a prescription for a Medicare-approved CGM
Medicare covers both the CGM device (E2103) and monthly supplies (A4239) when requirements are met.

Common Questions About Medicare CGM Coverage

What Does Medicare Part B Cover for CGM?

When you qualify, Medicare typically covers:

  • 80% of the approved amount for your CGM device
  • 80% of monthly supplies (sensors, transmitters)
  • Replacement devices when medically necessary

How Often Do I Need to See My Doctor?

Medicare requires:

  • Initial visit (in-person or telehealth) for CGM prescription
  • Follow-up visits every 6 months to maintain coverage
📅 Set calendar reminders for your 6-month check-ups to maintain continuous coverage.

Cost Considerations

Your out-of-pocket costs typically include:

  • Medicare Part B deductible ($240 in 2025)
  • 20% coinsurance for approved amounts
  • Any additional costs if your supplier doesn’t accept assignment

How to Get Started Today

Ready to explore your CGM coverage? Here are three simple steps:

  1. Call us at 888-649-5705 to verify your eligibility
  2. Use our online Coverage Checker tool
  3. Download our free Medicare CGM Guide
Need help understanding your Medicare Part B CGM requirements? Our team of Medicare specialists is here to help. Call 888-649-5705 for personalized assistance.

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