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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 therapeutic continuous glucose monitors (CGMs) and related supplies are covered by 
Medicare when all of the following coverage criteria are met: 
  1. The beneficiary has diabetes mellitus, 
  2. The beneficiary is insulin-treated with multiple (three or more) daily administrations of insulin or a 
Medicare-covered continuous subcutaneous insulin infusion (CSII) pump, 
  3. The beneficiarys insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of 
BGM or CGM testing results, 
  4. Within six (6) months prior to ordering the CGM, the treating practitioner has an in-person visit with the 
beneficiary to evaluate their diabetes control and determined that criteria (1-3) above are met; and, 
  5. Every six (6) months following the initial prescription of the CGM, the treating practitioner has an in-
person visit with the beneficiary to assess adherence to their CGM regimen and diabetes treatment plan. 
 
You can find this information in the Local Coverage Determination (LCD): Glucose Monitors (L33822). 
 
The rules state that equipment which the enrollee owns or is a capped rental item may be replaced in cases of 
loss or irreparable damage. Irreparable damage refers to a specific accident or to a natural disaster (e.g., fire, 
flood). A physicians order and/or new Certificate of Medical Necessity (CMN), when required, is needed to 
reaffirm the medical necessity of the item. Irreparable wear refers to deterioration sustained from day-to-day 
usage over time and a specific event cannot be identified. Replacement of equipment due to irreparable wear 
takes into consideration the reasonable useful lifetime of the equipment. If the item of equipment has been in 
continuous use by the enrollee on either a rental or purchase basis for the equipments useful lifetime, the 
enrollee may elect to obtain a new piece of equipment. Replacement may be reimbursed when a new physician 
order and/or new CMN, when required, is needed to reaffirm the medical necessity of the item. The reasonable 
useful lifetime of durable medical equipment is determined through program instructions. In the absence of 
program instructions, A/B MACS (B) may determine the reasonable useful lifetime (RUL) of equipment, but in 
no case can it be less than 5 years. Computation of the useful lifetime is based on when the equipment is 
delivered to the enrollee, not the age of the equipment. Replacement due to wear is not covered during the 
reasonable useful lifetime of the equipment. During the reasonable useful lifetime, Medicare does cover repair 
up to the cost of replacement (but not actual replacement) for medically necessary equipment owned by the 
enrollee. These rules can be found in the Medicare Benefit Policy Manual Chapter 15, Section 110.2 for 
Repairs, Maintenance, Replacement, and Delivery. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.