Is my Medicaid patient eligible for CGM?
Use the information on this page to help determine if your patient is eligible a CGM under Medicaid.
In general, Medicaid patients are eligible for CGM if they meet any of the following clinical criteria:
- Diagnosis of Type 1 diabetes.
- Diagnosis of Type 2 diabetes and require insulin dose adjustment within the last 12 months, or have a significant inability to adequately monitor blood glucose via fingerstick, or not require prandial insulin with A1C >7%.
- Have a history of significant or recurring hypoglycemia.
Providers must complete ODM Form 10277 Certificate of Medical Necessity: Continuous Glucose Monitor, include -33 modifier on the claim, and keep Form 10227 in the patient’s medical record.