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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that to be eligible for coverage of a continuous glucose monitor (CGM) and related supplies, the 
beneficiary must meet all of the following initial coverage criteria (1)-(5): 
 
1. The beneficiary has diabetes mellitus; and, 
2. The beneficiarys treating practitioner has concluded that the beneficiary (or beneficiarys caregiver) has 
sufficient training using the CGM prescribed as evidenced by providing a prescription; and, 
3. The CGM is prescribed in accordance with its Food and Drug Administration (FDA) indications for use; 
and, 
4. The beneficiary for whom a CGM is being prescribed, to improve glycemic control, meets at least one of the 
criteria below: 
   A. The beneficiary is insulin-treated; or, 
   B. The beneficiary has a history of problematic hypoglycemia with documentation of at least one of the 
following: 
      -     Recurrent level 2 hypoglycemic events that persist despite multiple attempts to adjust  
            medication(s) and/or modify the diabetes treatment plan; or, 
      -     A history of one level 3 hypoglycemic event characterized by altered mental and/or physical state 
requiring third-party assistance for treatment of hypoglycemia 
5. Within six (6) months prior to ordering the CGM, the treating practitioner has an in-person or Medicare-
approved telehealth visit with the beneficiary to evaluate their diabetes control and determined that criteria (1)-
(4) above are met.  
 
When a CGM (code E2102 or E2103) is covered, the related supply allowance (code A4238 or A4239) is also 
covered. Supplies (code A4238) for an adjunctive CGM integrated into an external insulin infusion pump are 
covered when the beneficiary meets both the CGM coverage criteria and the coverage criteria for an external 
insulin infusion pump. Refer to the External Infusion Pumps LCD (L33794) for additional information regarding billing a CGM receiver incorporated into an insulin infusion pump. 
 
If any of the initial coverage criteria (1)-(5), or the continued coverage criterion are not met, the CGM and 
related supply allowance will be denied as not reasonable and necessary. 
 
The supply allowance (code A4238 or A4239) is a monthly allowance that may be billed up to a maximum of 
three (3) units of service (UOS) per ninety (90) days at a time. Billing more than three (3) UOS per ninety (90) 
days of code A4238 or A4239 will be denied as not reasonable and necessary. 
 
Non-adjunctive CGM devices replace standard home blood glucose monitoring (BGMs) (codes E0607, E2100, 
E2101) and related supplies (codes A4233, A4234, A4235, A4236, A4244, A4245, A4246, A4247, A4250, 
A4253, A4255, A4256, A4257, A4258, A4259). Claims for a BGM and related supplies, billed in addition to a 
non-adjunctive CGM device (code E2103) and associated supply allowance (code A4239), will be denied.  
 
You can find this information in the Local Coverage Determination (LCD): Glucose Monitors (L33822). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.