Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A58213 (Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A58213: Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (Billing and Coding, effective 2026-09-10)
- Covered ICD-10-CM codes
- 373
- 1 group
- Non-covered ICD-10-CM codes
- 1
- Procedure codes listed
- 3
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| E08.00 | — |
| E08.01 | — |
| E08.10 | — |
| E08.11 | — |
| E08.21 | — |
| E08.22 | — |
| E08.29 | — |
| E08.311 | — |
| E08.319 | — |
| E08.3211 | — |
| E08.3212 | — |
| E08.3213 | — |
| E08.3291 | — |
| E08.3292 | — |
| E08.3293 | — |
| E08.3311 | — |
| E08.3312 | — |
| E08.3313 | — |
| E08.3391 | — |
| E08.3392 | — |
| E08.3393 | — |
| E08.3411 | — |
| E08.3412 | — |
| E08.3413 | — |
Procedure codes: 0446T, 0447T, 0448T.
Coverage indications, limitations and medical necessity
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.
History/Background and/or General Information
Covered Indications
I-CGMs are class III medical devices that require premarket approval by the Food and Drug Administration (FDA). In order to be considered reasonable and necessary, the FDA approved indication must include use as a therapeutic/non-adjunctive and non-therapeutic/adjunctive CGM. 1 The FDA recently approved expanding the indications of an implantable CGM product to replace finger stick blood glucose measurements for diabetes treatment decisions.
Therapeutic/non-adjunctive and non-therapeutic/adjunctive I-CGMs are considered reasonable and necessary by Medicare when all of the following coverage criteria (1-4) are met:
• The beneficiary has diabetes mellitus (Refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses); and,
• The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the I-CGM prescribed as evidenced by providing a prescription; and,
• The I-CGM is prescribed in accordance with its FDA indications for use; and,
• The beneficiary for whom a I- CGM is being prescribed, to improve glycemic control, meets at least 1 of the criteria below:
• The beneficiary is insulin-treated; or,
• The beneficiary has a history of problematic hypoglycemia with documentation of at least 1 of the following:
• Recurrent (more than 1) level 2 hypoglycemic events (glucose
I-CGM Continued Coverage
Every 6 months following the initial prescription of the I-CGM, the treating practitioner conducts an in-person or Medicare-approved telehealth visit with the beneficiary to document adherence to their I-CGM regimen and diabetes treatment plan.
Limitations
I-CGM devices will not be considered reasonable and necessary for short-term (72 hours to 1 week) diagnostic use.
Exception: For those beneficiaries who have previously met the coverage criteria for a non-implantable therapeutic/non-adjunctive and non-therapeutic/adjunctive continuous glucose monitor through the Medicare DME benefit and subsequently choose to switch to the implantable device, they may do so with a provider order. However, all other coverage criteria above must be fulfilled in order for Medicare payment.
Summary of evidence (opening)
Background
Diabetes mellitus is a chronic metabolic disease involving an underproduction or resistance to insulin, resulting in elevated blood glucose levels. The 2 most common types of diabetes are type 1 (T1DM) and type 2 (T2DM). 2 T1DM comprises approximately 5-10% of diabetes cases, and describes an etiology in which an autoimmune response damages the insulin-producing beta cells of the pancreas, resulting in insufficient insulin production. Conversely, T2DM is characterized by insulin resistance. 2,3 In T2DM, an individual’s insulin production fails to offset the deficit that is created by the resistance. 2 T2DM constitutes an estimated 90%-95% of diabetes cases. 3
Approximately 11.3% of Americans have diagnosed diabetes, and an additional 3.4% of Americans are estimated to have undiagnosed diabetes. The prevalence of diabetes is known to increase with age. In Medicare aged populations in the United States (≥ 65 years of age), 22.4% of the population has diagnosed diabetes, with an additional 4.7% estimated to have undiagnosed diabetes. 4 Economic evaluations have estimated that diabetes annually accounts for $237 billion in direct US medical expenditure, and an additional $90 billion in lost productivity. 5
Acute complications of diabetes include hypoglycemia, hyperglycemia, diabetic coma, and nonketotic hyperosmolar coma. Chronic hyperglycemia, resulting from poorly controlled diabetes, may result in serious and life-threatening damage, including dysfunction and failure of the eyes, kidneys, nervous system and cardiovascular system. The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. 2
The contractor cites 40 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2020-10-11
- Current revision effective
- 2026-06-25
- Last reviewed by the contractor
- 2026-05-21
- MCD version
- 18
The contractor lists 3 National Coverage Determinations as related: NCD 190.20 Blood Glucose Testing, NCD 40.1 Diabetes Outpatient Self-Management Training, NCD 40.2 Home Blood Glucose Monitors. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Other related documents: A59703 (Response to Comments).
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Wisconsin Physicians Service Insurance Corporation hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L38686 cover?
I-CGMs are class III medical devices that require premarket approval by the Food and Drug Administration (FDA). In order to be considered reasonable and necessary, the FDA approved indication must include use as a therapeutic/non-adjunctive and non-therapeutic/adjunctive CGM. 1 The FDA recently approved expanding the indications of an implantable CGM product to replace finger stick blood glucose measurements for… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L38686 apply to?
Wisconsin Physicians Service Insurance Corporation applies it to Medicare claims in AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L38686?
The companion billing and coding article A58213 lists 373 ICD-10-CM codes in 1 group that support medical necessity and 1 that do not; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L38686?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.