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February 20, 2024

Switching Glucose Monitor Supplies

Beneficiaries may make the choice to switch from non-adjunctive continuous glucose monitor (CGM) supplies back to blood glucose monitor (BGM) supplies.

If a beneficiary wishes to return to BGM testing, they may do so, and Medicare will consider payment for BGM supplies and discontinue paying for the non-adjunctive CGM supplies. However, Fee-For-Service (FSS) Medicare will not reimburse a new BGM monitor unless the non-adjunctive CGM is past the 5-year reasonable useful lifetime (RUL). Beneficiaries can use a BGM monitor that they own or purchase a new monitor as an out-of-pocket expense.

FFS Medicare allows beneficiaries to change back to standard BGM testing without additional documentation of medical necessity, other than documentation of a diabetes diagnosis. However, we strongly recommend that the beneficiary consult their treating practitioner beforehand.

When a beneficiary switches from the non-adjunctive CGM supplies back to BGM supplies, a supplier must submit a claim for the BGM supplies. If the BGM supplies deny, the supplier will need to submit a redetermination. Once CGS confirms the beneficiary has switched back to a BGM, we will discontinue allowing the CGM supplies for the beneficiary. The supplier may then resume submitting claims for BGM supplies.

We encourage suppliers to use the myCGS web portal to search beneficiary claim history for same or similar items before submitting a claim for supplies. You can also use the Interactive Voice Response (IVR)PDF (system). Press 1 for beneficiary information, then press 4 for diabetic supplies beneficiary claim history.

Centers for Medicare & Medicaid Services (CMS) considers BGMs and non-adjunctive CGMs to be same or similar equipment. The equipment is subject to the 5-year RUL restrictions on replacement. The BGM or CGM receiver is eligible for replacement prior to the 5-year RUL only if the item is lost, stolen, irreparably damaged, or if there is a change in medical condition.


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