Continuous glucose monitoring (CGM)
Learn how to identify eligible patients, navigate coverage, order CGM devices and support documentation and workflows in your practice.
Technology can improve care, but using it well requires preparation, support and clear processes.
Make CGM work in your practice
Continuous glucose monitoring (CGM) can transform diabetes care, but integrating it into your practice takes planning. From identifying the right patients to navigating insurance and streamlining workflows, there’s a lot to consider. Here, you'll find evidence-based practical tools, documentation tips and billing support to help you use CGM more effectively, no matter where you’re starting.
CGM In Your Practice: Implicit Bias
Identify patients who may benefit
Set expectations early by letting patients know that getting a CGM device may take more time and steps than filling a new prescription, but the benefits can be well worth it.
CGM in Your Practice: Shared Decision Making in Interpreting CGM Data with Patients
Based on the ADA Standards of Care in Diabetes, the document identifies the following as recommended candidates for Continuous Glucose Monitoring (CGM):
- People with Type 1 Diabetes
- Early initiation, ideally at or soon after diagnosis.
- Applies to youth and adults on any insulin regimen.
- People with Type 2 Diabetes
- Those on any type of insulin therapy (multiple daily injections, basal insulin, or pump).
- Consideration for adults on non-insulin glucose-lowering medications to help achieve individualized glycemic goals.
- Pregnant Individuals
- With Type 1 diabetes (strong recommendation).
- May be beneficial for other types of diabetes in pregnancy (individualized decision).
- Individuals at Risk for Hypoglycemia, especially those with hypoglycemia unawareness or frequent episodes.
- People Who Can Use the Device Safely
- Either independently or with caregiver support.
- Includes ability to perform training and ongoing use.
- When Consistent Use Is Not Feasible
- Periodic use of personal or professional CGM can be considered for medication or lifestyle adjustments.
Additional Notes
- CGM should be used as close to daily as possible for maximal benefit.
- Intermittently scanned CGM (isCGM) should be scanned at least every 8 hours to avoid data gaps.
- Education and training are essential for successful use.
- Skin reactions and interfering substances should be assessed and managed.
Understanding insurance coverage
Coverage for CGM varies based on the payer and plan.
Coverage by market segment
| Market | Covered? | Benefit provided through pharmacy or medical |
| Traditional Medicare | Yes | Durable medical equipment (DME) only |
| Medicare Advantage | Yes | Varies by plan |
| Medicaid | Most state plans |
Varies by state and plan; |
| Commercial insurance | Yes, for many |
Varies by plan and source of coverage (i.e., may see differences between group and individual plans) |
Note: Eligibility requirements vary widely across payers and even between plans from the same payer, making it difficult to provide universal guidance.
Tip: Designate a CGM champion in your clinic to track your top payers’ requirements. Learn more in Implement CGM in your workflow.
Medicare coverage requirements
Medicare coverage requirements are standardized and publicly available, so they’re included here for reference. Requirements for commercial insurance, Medicaid, and patients without coverage vary and are addressed in the brand-specific tabs.
A patient must meet all requirements to qualify for CGM under Medicare. They must:
Have been diagnosed with diabetes
Use a CGM that’s prescribed following FDA indications
Have been trained (patient or caregiver) on how to use the CGM
Meet one of the following clinical criteria:
- Receive insulin therapy
- Have documented problematic hypoglycemia, such as:
- Two or more level 2 hypoglycemic events (glucose <54 mg/dL) that persist despite multiple modifications to the treatment or medication plan
- One level 3 hypoglycemic event (glucose <54 mg/dL) characterized by altered mental and/or physical state requiring third-party assistance for treatment.
Note: Medicare also requires use of a dedicated reader device; smartphones alone do not qualify. Clinicians must order CGM devices through a DME supplier for patients with Medicare coverage."
Ordering and authorization
Ordering CGM requires more than a prescription. Practices need systems in place to confirm eligibility, navigate prior authorization, coordinate with suppliers and plan for reauthorization. Most payers have distinct requirements, and many require reapproval every six to 12 months.
Key steps:
Check prior authorization requirements for the patient’s plan and brand.
Submit supporting documentation with the prescription.
Choose the correct supplier based on coverage type (pharmacy vs. DME).
Inform patients they may receive vague messages from the supplier or pharmacy about a medical device. Educate them that they will need to follow up if they receive a call in order to get the prescription filled.
Schedule a follow-up visit within six months to evaluate diabetes management and continue eligibility; check the insurer's guidelines as to whether visit can be via telehealth or in-person.
Track reauthorization timelines and build checkpoints into your EHR and communications.
Tips for Successful Ordering
Use tools like the DiabetesWise Providers Prescription Assistant Tool to identify brand- and payer-specific requirements
Reference ADA or Medicare guidelines in chart notes
Use consistent language across documentation and orders
Educate patients on the importance of responding to supplier outreach
The resource, Expanding Medicaid Access to Continuous Glucose Monitors, contains a map and detailed table in Appendix A outlining each state’s coverage for type of diabetes, population (pediatrics/adults/both), benefit from pharmacy or DME, requirements for minimum of 4 daily finger stick glucose checks, and prescriber specialty.
Documentation and ordering resources:
Medicare detailed written order (for Dexcom and other brands)
CGM documentation samples (e.g., chart notes, smartphrases, macros)
CGM in your workflow
The American Academy of Family Physicians (AAFP) conducted focus groups to explore the barriers to successfully implementing and using CGM in primary care settings and determine potential solutions. Use these tips and resources to develop a team-based system to support CGM efficiently.
Tips for success:
Assign a CGM workflow lead.
Preload order templates and documentation language in your EHR.
Empower patients through education and shared decision-making.
Bill for CGM
CGM can be billed separately or in addition to an evaluation and management visit when criteria are met.
Common current procedural terminology (CPT) codes:
95249: Startup of personal CGM
95250: Startup of professional CGM (includes sensor placement and training)
95251: Interpretation of at least 72 hours of CGM data
Documentation and billing tips:
For CPT 95250: “Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording.” This may be performed by any qualified staff member under the direct supervision of a physician, physician assistant, or nurse practitioner. It is billed as often as every 90 days for most payers.
For CPT 95251: “Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.” It may only be reported by a physician, nurse practitioner, or physician assistant. 1.02 RVUs; typically pays about $35 Medicare
An evaluation and management (E/M) service can only be reported on the same date as CGM services if the E/M service is medically necessary and significant and separately identifiable from the CGM service. Append modifier -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to the E/M code when reporting CPT codes 95250 or 95251 on the same date.
Confirm payer-specific frequency limits and bundling rules.
Use valid International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-11-CM) diagnosis codes.
For federally qualified health centers and rural health clinics, consider diabetes-related grants to cover equipment.
Resource: Search the Physician Fee Schedule | CMS
CGM documentation examples
These examples reflect documentation language for CGM interpretation (e.g., smartphrases, dotphrases or auto text). You can adapt them for use in chart notes, EHR templates, or prior authorization materials.
Example of initial documentation of CGM eligibility (Medicare patients)
This patient has a diagnosis of diabetes; is treated with three or more daily administrations of insulin or continuous insulin infusion via pump; requires frequent adjustment of the insulin treatment regimen based on glucose results; and has been personally seen to evaluate their diabetes treatment within the past six months.
Example of supporting CGM use based on American Diabetes Association standards of care (commercial payers or appeals)
This patient is treated with insulin and would benefit from use of a continuous glucose monitor (CGM), as recommended in the American Diabetes Association Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers (Clin Diabetes 2022;40(1):10–38). Recommendation 7.11 states that CGM should be offered for diabetes management in adults with diabetes on multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) who are capable of using devices safely (either by themselves or with a caregiver). Recommendation 7.12 states that CGM can be used for diabetes management in adults with diabetes on basal insulin who are capable of using devices safely. In both cases, the choice of device should be made based on patient circumstances, desires and needs.
CGM brand comparison
Use the tabs to find product descriptions, insurance guidance, ordering instructions and patient support details for each CGM brand, including options for patients without coverage.
CGM brands: Coverage, ordering and support
Abbott FreeStyle Libre 2 or 3 System
Abbott’s FreeStyle Libre is a widely used CGM system with pharmacy and DME options depending on payer. Prescribing steps and device requirements differ for Medicare and commercial plans, and support is available for patients without coverage.
Use the instructions below to guide Medicare and commercial ordering and support patients without coverage.
Medicare:
Complete the Medicare standard written order (SWO); although it asks for test frequency, this is no longer a requirement.
Fax the SWO and chart notes to an approved DME supplier listed on the order form.
Prescribe a reader, even if the patient uses a smartphone (reader life is about 3 years).
Commercial/private:
Confirm smartphone compatibility [link is broken]
Prescribe two 14-day sensors (28-day supply) with 11 refills.
Prescribe one reader (lifespan is about 3 years) if the patient lacks a compatible device.
Freestyle Libre 2 or 3 prescriptions are covered primarily through pharmacies under the pharmacy benefit. Most patients pay $60-$80/month.
If commercially insured, or uninsured, and asked to pay over $75 for two sensors, give Abbott’s copay card to patients.
FreeStyle Libre Copay Card (call 844-330-5535 if over).
Patients without coverage:
Use samples or vouchers when available via MyFreeStyle or discount cards.
Offer a self-pay option.
Use discount tools like GoodRx, SingleCare, Costco or Sam’s Club to reduce out-of-pocket costs.
Share the “What if CGM isn’t covered?” handout (English) (Spanish) with patients.
Practices may also consider professional CGM as a first step. The Pro CGM use in your clinic section offers information on equipment, billing and implementation details.
Additional FreeStyle Libre resource: Application and data retrieval
Pro CGM use in your clinic
Pro CGM is owned by the clinic and used by patients short-term, typically over several days. It can be a useful option when personal CGM isn’t covered, helping to uncover glucose patterns and support treatment decisions. Some systems use a reusable reader, while others allow patients to view data on their smartphones.
Where to get it
Your clinic can obtain professional CGM systems and sensors by purchasing them directly from the manufacturer or through a medical supplier.
This video introduces you to professional CGM and how to implement ProCGM into your practice.
CGM in Your Practice: Professional CGM
Benefits of Pro CGM:
Provides intermittent CGM access without requiring patient ownership
Helps clarify diagnosis in cases where A1C is unreliable (e.g., anemia or chronic kidney disease)
Does not typically require insurance authorization
Allows data to be blinded or visible to patients
Can be billed using CPT codes and is reimbursable
Common CPT codes for Pro CGM
95250: Sensor placement, training and data capture
95251: Data review, analysis and interpretation
Note: You cannot report CPT codes 95250 and 95251 more than once per calendar month.
The national average Medicare allowable for these services is approximately $147 (based on the Medicare physician fee schedule lookup tool). Medicare rates and requirements vary by region, so be sure to check with your Medicare administrative contractor for local policies.
Equipment and estimated costs
Reusable reader: About $60–$65 each; many clinics order a spare or assign one per work area or pod.
Single-use sensor: About $60 per patient
Federally qualified health centers and rural health clinics may use diabetes-related grant funding to help cover equipment costs.
Professional CGM devices and sensors can be purchased directly from manufacturers or through medical suppliers.
Implementation tools
Instructional videos, guides and sample documentation and macro templates for data interpretation (Freestyle Libre Pro tools, Dexcom G6 Pro tools)
Sample documentation language for CGM interpretation, including smartphrases and dotphrases (see CGM documentation examples)
This resource is supported by an educational grant to the American Academy of Family Physicians (AAFP) from Abbott Diabetes Care.