Understanding Your Medicare CGM Benefits Statement

Receiving your Medicare CGM benefits statement can feel overwhelming, but understanding this important document is key to managing your diabetes care costs. As trusted Medicare CGM specialists, we’ll help you decode your statement and ensure you’re getting the coverage you deserve.

This guide provides general Medicare information and should not be considered medical advice. Always consult your healthcare provider and verify coverage with Medicare.

What Is a Medicare CGM Benefits Statement?

A Medicare CGM benefits statement (officially called a Medicare Summary Notice or MSN) is a quarterly report showing what continuous glucose monitoring services and supplies Medicare has covered. This document helps you track your diabetes care expenses and verify proper billing.

Your Medicare CGM benefits statement shows:

Which CGM supplies were billed to Medicare
How much Medicare approved and paid
What you may owe after Medicare’s payment
Important notes about your coverage status

How to Read Your Medicare CGM Benefits Statement

Let’s break down the key sections you’ll find on your statement:

1. Service Description

Look for entries labeled with code E2103 (CGM system) or A4239 (supplies). These codes tell you exactly what was billed for your continuous glucose monitoring care.

2. Service Dates

Check that dates match when you received supplies or services. For monthly CGM supplies, this should align with your regular delivery schedule.

Keep a calendar of when you receive CGM supplies. This makes it easier to verify your Medicare CGM benefits statement is accurate.

Understanding Your Coverage in 2025

Medicare covers CGM systems and supplies when you meet these requirements:

Diagnosed with Type 1 or Type 2 diabetes
Completed CGM training (your prescription confirms this)
Either use insulin OR have documented problematic hypoglycemia
Had a provider visit within 6 months

Common Questions About Your Medicare CGM Benefits Statement

What If I See a Mistake?

If you spot an error on your Medicare CGM benefits statement, take these steps:

Circle the incorrect item on your statement
Call 888-649-5705 for assistance reviewing the charge
File an appeal within 120 days if needed

As of 2025, Medicare no longer requires using insulin 3+ times daily for CGM coverage. This expands access to more beneficiaries managing diabetes.

Taking Action on Your Statement

Follow this monthly checklist to stay on top of your CGM coverage:

Review statements when they arrive
Compare against your supply delivery dates
File paperwork for your records
Schedule required provider visits

Set calendar reminders for 6-month provider visits to maintain continuous coverage.

Need help understanding your Medicare CGM benefits statement? Our specialists are here to help. Call 888-649-5705 to review your coverage details today.

Last updated: January 2025

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