Medicare's recent decision to increase coverage of CGM for patients with T2D who aren't on insulin is a 'win-win,' says Anne L. Peters, MD.
Let me review the new rules. First, anybody who takes insulin, no matter their type of diabetes and no matter how many injections, qualifies for CGM. In addition, people who aren't on insulin but are having episodes of hypoglycemia are also eligible for CGM. There's a number of qualifying features for those individuals.
It's harder to document these level 2 hypoglycemia episodes because these people aren't on CGM and it requires they do fingersticks to prove their glucose levels are < 54 mg/dL. Most of my patients just treat an episode of hypoglycemia that's < 54 mg/dL rather than do a fingerstick. These benefits have already gone into effect. They started on April 17, 2023, and don't require an in-person visit to qualify. Telemedicine visits also help an individual qualify for these benefits.
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