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CMS Expands CGM Coverage to All Patients on Insulin or Those Who Have a History of Problematic Hypoglycemia

March 2, 2023
Coverage and Benefit Design
Guidelines / Policy

The Centers for Medicare and Medicaid Services (CMS) expanded CGM access to beneficiaries on basal-only insulin and those with a history of level two or three hypoglycemia. Although the Local Coverage Determination (LCD) was originally anticipated to be implemented in July, CMS will enact expanded access to CGM on April 16, 2023. This new coverage policy is aligned with consensus guidelines from the ADA and AACE, which recommend CGM for all patients on insulin at the outset of diagnosis. The new LCD, which was proposed in 2022, also removes the term “daily” as a descriptor for insulin to account for potential FDA approval of weekly insulins in the future.

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