Why Did Medicare Deny My CGM? Top 10 Reasons

Has Medicare denied your Continuous Glucose Monitor (CGM) coverage? You’re not alone. Understanding why Medicare might deny CGM coverage is the first step to getting the diabetes management tools you need. Let’s explore the top 10 medicare deny cgm reasons and what you can do about them.

The Most Common Reasons Medicare Denies CGM Coverage

Medicare has specific requirements for CGM coverage. Missing even one requirement can result in a denial. Here are the top reasons your CGM claim might be rejected:

1. Incomplete Documentation of Diabetes Diagnosis

Medicare requires clear documentation of Type 1 or Type 2 diabetes. Your medical records must show an official diagnosis with the correct ICD-10 code.

2. Missing Recent Doctor’s Visit

You must have had a face-to-face or telehealth visit with your healthcare provider within 6 months of your CGM request.

3. No Documentation of CGM Training

Your doctor must confirm that you or your caregiver has been trained to use the CGM system. The prescription typically serves as evidence of this training.

4. Insufficient Evidence of Need

As of 2025, you must meet one of these criteria:

• Currently using insulin
• Have documented problematic hypoglycemia:
  • 2 or more Level-2 events (blood sugar below 54 mg/dL)
  • OR 1 or more Level-3 event requiring assistance

What to Do If Medicare Denies Your CGM

Don’t give up if Medicare denies your CGM coverage. Here are your next steps:

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