Traditional MedicareCoverageHigh impact
Implantable Continuous Glucose Monitors (I-CGM)
Medicare/CMS - LCD·Endocrinology, Internal Medicine, Family Medicine +1 more·Local Coverage Determination
Effective date
Jun 25, 2026
We identified it
Jun 25, 2026
Summary
WPS Insurance Corporation (Medicare Part A and Part B MAC) has issued a new Local Coverage Determination (L38686) for Implantable Continuous Glucose Monitors (I-CGM) effective June 25, 2026. This policy establishes coverage rules, medical necessity criteria, and billing requirements for I-CGM devices. Billing teams must review the full policy text to identify specific codes, prior authorization requirements, and documentation standards that will apply to Medicare claims.
Action Required
By June 25, 2026: Billing team must access the full policy text at https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38686&ver=18 to identify specific CPT and HCPCS codes for I-CGM devices and supplies. Update billing system rules to enforce any prior authorization requirements for I-CGM claims submitted to WPS MAC (Part A and Part B). Verify medical necessity documentation requirements and add to provider templates. Train billing staff on new coverage criteria. Providers must document medical necessity according to policy guidelines. Failure to comply may result in claim denials or recoupment of incorrectly billed claims.