Implantable Continuous Glucose Monitors (I-CGM)

Medicare covers implantable continuous glucose monitors (I-CGM) when the device is FDA-approved for therapeutic CGM use and the beneficiary has diabetes mellitus, the prescriber documents that the beneficiary or caregiver has sufficient training (evidenced by a prescription), and the device is prescribed per FDA indications. Coverage requires that the beneficiary be insulin-treated or have documented problematic hypoglycemia (recurrent level 2 events or at least one level 3 event); continued coverage requires a practitioner visit every six months to document adherence and treatment. I-CGMs are not covered for short-term (72 hours to 1 week) diagnostic use, and beneficiaries switching from a non-implantable therapeutic CGM must meet all coverage criteria with a provider order.

"Beneficiary has diabetes mellitus (diagnosis must be an applicable ICD-10 diabetes code per the LCD-related Policy Article)."