HMSA Medicare Advantage Continuous Glucose Monitor

Effective Date

January 1, 2025

Continuous Glucose Monitor Policy

All HMSA Medicare plans, including HMSA Akamai Advantage® (PPO), HMSA Akamai Advantage Dual Care (PPO D-SNP), and Employer Group Waiver Plans (EGWP), will apply the Local Coverage Determination (LCD) L33822 indications whether the member obtains their continuous glucose monitors (CGM) and supplies from a pharmacy or through a certified durable medical equipment (DME) supplier.

Background

Medicare Part B covers CGMs and related supplies. CGMs and related supplies are Part B benefits that are covered at no cost to the member under our Medicare Advantage plans.

• A non-adjunctive CGM can be used to make treatment decisions without the need for a stand-alone blood glucose monitor (BGM) to confirm test results.
• An adjunctive CGM requires the user to verify their glucose levels or trends displayed on a CGM with a BGM before making treatment decisions.

Preferred Brands and Manufacturers

As allowed by the Centers for Medicare & Medicaid Services, HMSA has designated the following preferred brands and manufacturers for CGMs:

• FreeStyle Libre
• Dexcom

Note: All supplies that can be used with the above brands are covered by the plan. Please verify availability of brands at your local pharmacy or DME supplier.

Revision History