take immediate action and work with the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of continuous glucose monitors (CGMs) for the millions of Americans living with diabetes
Work with the Centers for Medicare and Medicaid Services to expand Medicare coverage of continuous glucose monitors for all beneficiaries with diabetes.
Occurrences
Use its existing regulatory authority to expand Medicare coverage of CGMs to all beneficiaries with diabetes
Evidence
unverified · Source version 76924 · locator unknown
If you have diabetes, Medicare may cover a continuous glucose monitor and related supplies (like sensors) if your doctor or other health care provider orders them for you and you meet the following conditions.
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For the in-person or Medicare-approved telehealth treating practitioner visit that is required as part of the initial provision of a CGM, there must be sufficient information in the beneficiary’s medical record to determine that the beneficiary has diabetes mellitus ... the CGM is being prescribed to improve glycemic control for a beneficiary who is insulin treated or has a history of problematic hypoglycemia.
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CONTINUOUS GLUCOSE MONITORS (CGMs) ... beneficiaries taking oral medication to treat their diabetes are not insulin-treated.
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The FDA recently approved expanding the indications of an implantable CGM (I-CGM) product to replace fingerstick blood glucose measurements for diabetes treatment decisions.
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Congresswoman Nanette Barragán (CA-44), a member of the Energy & Commerce Subcommittee on Health, led 19 of her colleagues in a letter urging the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to reinstate the collection of demographic data and requirement for health equity plans at the Center for Medicare and Medicaid Innovation (CMMI).
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Medicare’s coverage page says CGM may be covered for beneficiaries with diabetes only when a doctor orders it and the person either takes insulin or has a history of problematic hypoglycemia, with training requirements also applying.
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CMS’s policy article continues to set CGM documentation rules tied to insulin treatment and problematic hypoglycemia, confirming the federal policy remains conditional rather than universal.
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Medicare.gov's current coverage page says CGMs may be covered for diabetes only when a provider orders them and the beneficiary meets eligibility conditions, including insulin use or a qualifying hypoglycemia history.
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The currently effective LCD requires diabetes, training, FDA-consistent prescribing, and either insulin treatment or documented problematic hypoglycemia, plus a recent practitioner visit.
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CMS lists the A52464 public version as updated April 15, 2026 and currently in effect; its documentation rules still tie CGM coverage to insulin treatment or problematic hypoglycemia.
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CMS's 2023 revision history says it removed frequent insulin-dosing requirements and added pathways based on problematic hypoglycemia.
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The LCD revision history says CMS removed the prior multiple-daily-insulin-administration condition and added an initial coverage criterion for problematic hypoglycemia.
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Meet 1 of these criteria: The patient is insulin-treated The patient has a history of problematic hypoglycemia
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I urge CMS to use its existing regulatory authority to expand Medicare coverage so that all beneficiaries with diabetes can access CGM technology.
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Per the CY 2026 Home Health Prospective Payment System final rule, we’ll pay for CGMs and insulin infusion pumps, including necessary supplies and accessories, under the DMEPOS fee schedule and Competitive Bidding Program (CBP) on a bundled monthly rental basis, starting January 1, 2028.
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If you have diabetes, Medicare may cover a continuous glucose monitor and related supplies (like sensors) if your doctor or other health care provider orders them for you and you meet the following conditions:
verified · Source version 76924 · locator 1168
You take insulin or have a history of problems with low blood sugar (hypoglycemia).
unverified · Source version 76926 · locator unknown
To be eligible for coverage of a CGM and related supplies, the beneficiary must meet all of the following initial coverage criteria (1)-(5):
unverified · Source version 76926 · locator unknown
The beneficiary is insulin-treated; or, The beneficiary has a history of problematic hypoglycemia
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Use its existing regulatory authority to expand Medicare coverage of CGMs to all beneficiaries with diabetes;
Assessments
Barragán made a direct CMS/HHS-directed request to expand Medicare CGM coverage to all beneficiaries with diabetes, so there is documented effort. However, verified Medicare guidance as of 2026 still says coverage is conditional: a provider must order the CGM and the beneficiary must meet additional criteria such as insulin use or a history of hypoglycemia. Because the promised universal expansion has not been shown enacted, and there is no expired deadline, the outcome remains unresolved rather than delivered or partial.
Medicare/CMS policy now covers continuous glucose monitors for some beneficiaries with diabetes, and CMS expanded eligibility by removing prior frequent insulin-dosing requirements and adding a pathway for problematic hypoglycemia. However, current Medicare and CMS coverage documents still require provider ordering, diabetes-related documentation, training, and either insulin treatment or qualifying hypoglycemia history. That falls short of the promise to expand CGM coverage for all Medicare beneficiaries with diabetes. The evidence does not show Barragán specifically authored, sponsored, or materially advanced the CGM expansion, so this is partial credit for a related federal policy expansion rather than full delivery.
Medicare/CMS has expanded CGM coverage, but the current federal policy still limits coverage to beneficiaries who meet medical criteria such as insulin use or problematic hypoglycemia, not all beneficiaries with diabetes. That means the promise was only partially fulfilled. The evidence provided shows later-term CMS policy implementation, but no strong proof that Barragán directly drove a universal expansion, so this is partial credit rather than full delivery.
Medicare/CMS policy has expanded continuous glucose monitor coverage, so the promise saw meaningful movement. However, the available CMS and Medicare sources indicate coverage is still conditional rather than available to all Medicare beneficiaries with diabetes: eligibility remains tied to criteria such as insulin treatment or a history of problematic hypoglycemia and physician documentation. That means the exact promise to expand coverage for all beneficiaries with diabetes was not fully achieved. The outcome therefore merits partial credit, with later_term timing because the broader coverage status is documented after the pledge period. The record provided does not show Barragán herself directly secured the final policy change beyond the general promise, so full delivery is not warranted on candidate-credit grounds.