Clinical tools · Prescription CGM

Prescription CGM: from selection to start

Coordinate clinical selection, access, prescription, fulfillment, training and follow-up with the person and care team.

Created bydanatech Clinical Staff

Clinical reviewPatty Scalzo, MSN, ANP-BC, CDCES
ADCES Clinical Team

Last updatedNovember 2026

Adult not using insulin, with no need for alerts or device integration? Use the OTC workflow

Start here: how will the prescription CGM be obtained?

Confirm the plan against the person’s benefits as you work. Self-pay stays in this workflow; lack of coverage doesn’t make a person suitable for OTC CGM.

Not yet determinedInsurance coverageSelf-pay or assistance

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Checklist status

Checked = completed; N/A = not applicable. Completion records selected checks, not clinical readiness.

Select the prescription CGM

Match the prescribed system to clinical needs and preferences. Keep the choice provisional until access and ongoing costs are confirmed.

1Step 1: Discuss goals, priorities, and concernsTypical leadPrescriberDCES / educatorMay supportNursePharmacistPerson / care partner

Use shared decision-making to understand what the person wants from continuous glucose monitoring (CGM), what matters in daily use, and what could make continued use difficult.

Step 1 checklist

Discuss the person’s goals and which CGM capabilities could support them.
Examples and details
- Understand glucose patterns and the effects of meals, activity, or medication; reduce fingerstick burden.
- Reduce hypoglycemia exposure or receive glucose alerts, when supported by the selected system.
- Integrate with an automated insulin delivery (AID) system or share data with a chosen care partner.
- Improve hemoglobin A1C (A1C) or time in the agreed glucose range.
- Monitor ketones only when considering a system specifically authorized to measure both glucose and ketones.
Discuss cost, alerts, skin reactions, insertion concerns, device visibility, data reliability, and any other concerns.
Document the agreed goals, priorities, and concerns in the clinical record.

2Step 2: Review clinical needs and support requirementsTypical leadPrescriberDCES / educatorMay supportNursePharmacistPerson / care partner

Review the factors that determine clinical suitability. Insurance eligibility is a separate question and does not establish whether a product is appropriate.

Step 2 checklist

Confirm age, relevant diagnosis, and pregnancy status when applicable; check these against the labeling of candidate devices.
Review the treatment plan, medications, insulin regimen if used, and available A1C or glucose information.
Review the current monitoring approach and access to a blood glucose meter. Document testing frequency only when clinically relevant or specifically required by the payer.
Identify the insulin delivery method, if any, and the exact model when device integration is intended.
Examples and details
- AID pump, pump used without automation, or standalone patch pump.
- Connected pen, non-connected pen or syringe, or inhaled insulin.
- No insulin use.
Assess hypoglycemia frequency, severity, and awareness, including events requiring help from another person. Use a validated awareness assessment when helpful.
Assess ketone risk and the need for a separate ketone-monitoring plan when clinically relevant.
Identify language, vision, hearing, dexterity, cognitive, digital-access, or other support needs. Agree on accommodations and care-partner involvement, if desired.
Document relevant findings and the support plan in the clinical record.

3Step 3: Identify clinically suitable CGM optionsTypical leadPrescriberDCES / educatorMay supportNursePharmacistPerson / care partner

Build a short list using clinical needs, current product labeling, desired capabilities, and personal preferences. Having a connected pen does not itself require a particular CGM; compatibility matters when integration with that pen’s software is intended.

Step 3 checklist

Use current manufacturer labeling, the danatech Find and Compare CGMs tool (opens in a new tab) and the CGM Selection Assistance tool (opens in a new tab) to identify options suitable for the person’s age, treatment, and intended use.
If AID or connected-pen integration is intended, confirm the exact CGM model, pump or pen software, and supported configuration with current manufacturer information. For AID starts, use the danatech AID Initiation Workflow (opens in a new tab).
Discuss the benefits, limitations, alerts, wear requirements, and daily-use demands of suitable options; agree on a provisional short list.

4Step 4: Confirm the access plan and available alternativesTypical leadPrescriberDCES / educatorMay supportPharmacistPractice support / coordinatorPerson / care partner

Confirm how the prescription CGM will be obtained. Insurance eligibility is separate from clinical suitability; an Rx device still requires a prescription when self-paid.

Record the access plan using the choice above the checklist. If it changes, review earlier checks and the final product selection.

Step 4 checklist

Check the relevant coverage criteria and identify any likely access barriers without treating insurance eligibility as a measure of clinical suitability.
If coverage is denied or insufficient, review the reason and appropriate alternatives, such as an appeal (opens in a new tab), covered clinically suitable product, self-pay, or assistance.
If using self-pay or assistance, check program eligibility in the Affordability Program Finder (opens in a new tab), availability, and expected ongoing cost. Confirm that the person wants to explore this route.

5Step 5: Confirm display, compatibility, and supply requirementsTypical leadDCES / educatorNurseMay supportPrescriberPractice support / coordinatorPharmacistPerson / care partner

Check the technical requirements for the provisional choice. A compatible dedicated reader may be an option for some systems; a smartphone is not a universal requirement.

Step 5 checklist

Confirm access to a compatible smartphone and supported operating system, or a dedicated reader, as supported by the system and intended use.
If using a pump, connected pen, or data-sharing feature, verify that the planned display and software configuration supports that feature.
Identify all required components, such as sensors, applicator, overpatch, transmitter, reader, and charging supplies, as applicable.
Agree on any support needed for setup, access, or ongoing use.

6Step 6: Agree on a provisional choice and backup monitoring planTypical leadPrescriberDCES / educatorMay supportNursePerson / care partner

Record the preferred option and required supplies. Confirm the final product with the person after benefit verification and initial and ongoing costs are known.

Step 6 checklist

Document the preferred brand and model, clinical rationale, alternatives if needed, and required components.
Confirm access to a blood glucose meter, strips, and lancets for backup checks and any device-required confirmation or calibration. Include prescriptions when needed.

Confirm access and order the CGM

Verify benefits when using insurance, confirm the final product and cost, and complete the prescription and supporting documentation. Self-pay stays within this prescription workflow.

7Step 7: Verify insurance benefits, cost, and the final choiceTypical leadPractice support / coordinatorPharmacistSupplier staffMay supportDCES / educatorNursePrescriberPerson / care partner

Separate the benefit category from the dispensing location. A pharmacy or supplier may dispense a product, while an implantable system may also require a separately covered insertion service.

Step 7 checklist

Confirm the health plan, member information, and current coverage rules in the appropriate clinical or administrative system.
Confirm whether coverage is through the pharmacy or medical benefit, including durable medical equipment (DME). For an implantable system, also verify coverage and cost of insertion and removal services.
Examples and details
- DME is a medical-benefit category; retail or mail order describes where a product is dispensed.
Confirm the exact covered product, required components, in-network pharmacy or supplier, quantity limits, refill rules, and any replacement restrictions.
Confirm documentation, encounter, and prior authorization requirements with the specific plan. For Medicare DME CGM coverage, verify the qualifying practitioner visit within six months before ordering and the other initial coverage criteria.
Confirm estimated initial and recurring out-of-pocket costs, explain what remains uncertain, and check whether the person can obtain and sustain the system.
Confirm the final product and cost with the person before ordering. If access changes the choice, return to Steps 3–6 and recheck suitability and compatibility.

8Step 8: Submit a complete prescription to the correct destinationTypical leadPrescriberMay supportDCES / educatorPractice support / coordinatorPharmacistSupplier staff

An Rx device requires a prescription even when insurance is not being used. Finalize self-pay or assistance costs with the person before ordering.

Step 8 checklist

For self-pay or assistance, confirm the final clinically suitable product, dispensing destination, estimated initial and recurring cost, and the person’s agreement to proceed.
Specify the exact device and required components, quantity, days of supply, and refills as appropriate.
Include diagnosis information and any required DME ordering details or codes, following payer and supplier instructions. Verify codes with the receiving supplier when needed.
Confirm prescriber identification, signature, and date; send the prescription to the appropriate pharmacy, supplier, or implanting practice.
Confirm receipt and identify who will resolve any missing information.
Confirm backup blood glucose monitoring supply prescriptions are current, using the appropriate benefit or dispensing route.

9Step 9: Document clinical rationale and complete required payer formsTypical leadPrescriberMay supportDCES / educatorNursePractice support / coordinator

Keep supporting clinical documentation distinct from additional payer or supplier forms. The Centers for Medicare & Medicaid Services (CMS) eliminated Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs) for dates of service from January 1, 2023, but supporting medical-necessity documentation is still required. A supplier form does not replace the clinical record.

Step 9 checklist

Record the diagnosis, current treatment, clinical rationale for the selected system, and relevant training or support plan.
Document the clinical facts supporting this plan’s CGM criteria. Insulin treatment is not limited to multiple daily injections; record noninsulin therapy and qualifying hypoglycemia when relevant.
For Medicare DME CGM coverage, confirm documentation of the qualifying encounter and all initial coverage criteria. Check the current CMS policy (opens in a new tab) rather than treating this checklist as a complete coverage rule. Mark N/A when this Medicare requirement does not apply.
Confirm whether the plan or supplier requires an additional medical-necessity form or signed statement. Complete it only when required.
Send the required supporting documentation through the appropriate secure process, following payer and supplier instructions.

10Step 10: Resolve authorization or other access barriersTypical leadPractice support / coordinatorMay supportPrescriberDCES / educatorPharmacistSupplier staffPerson / care partner

Confirm whether prior authorization (PA) is required. If not, mark only the PA tasks N/A. Keep the access-resolution checkpoint active. For self-pay or assistance barriers, use the same approach with the relevant supplier or program.

For additional help, use the danatech Prior Authorization guide (opens in a new tab) and Affordability Program Finder (opens in a new tab). Record patient-specific details and handoffs in the clinical record; this tool does not transmit them to other team members.

Step 10 checklist

Confirm whether this plan and device require prior authorization.
If PA is required, use the plan’s current submission process (see the danatech Prior Authorization guide (opens in a new tab)) and include the required supporting clinical documentation.
Record the submission date, responsible staff member, and planned status-check date in the appropriate clinical or administrative system.
Track the request and respond to additional-information requests until the outcome is known.
Confirm access is resolved. If denied, delayed, unavailable, or unaffordable, identify the reason, assign the next action and owner, agree on a review date, and tell the person what will happen next.
If access is unresolved, confirm an interim glucose-monitoring plan and link the person to appropriate support, such as Responding to a PA denial (opens in a new tab) or the Affordability Program Finder (opens in a new tab). Use the existing danatech access resources rather than starting a separate process.

Obtain the device and support a safe start

Confirm the device is available, arrange appropriate training, and agree on follow-up and support. Tailor the start process to the person and device.

11Step 11: Confirm receipt and arrange training or insertionTypical leadPractice support / coordinatorNurseMay supportDCES / educatorPharmacistSupplier staffPerson / care partner

Arrange training with a healthcare professional who is trained in the device and working within local scope and protocols. For an implantable system, also arrange insertion with an appropriately trained clinician.

Step 11 checklist

Confirm the access outcome and agreed costs have been communicated to the person.
Confirm dispensing or shipping and receipt of all components; arrange an insertion appointment for an implantable system, if applicable.
Agree on the training format, trainer, timing, and language or accessibility support. Manufacturer training (see danatech Device trainings (opens in a new tab)) may supplement the clinical team’s plan.
Provide setup instructions suited to the selected system, such as installing the app, setting up the reader, or creating an account when required.

12Step 12: Start CGM, confirm essential skills, and arrange follow-upTypical leadDCES / educatorNurseMay supportPrescriberPharmacistPerson / care partner

Use device-specific instructions and teach-back. Before ending the start session, confirm that the person or chosen care partner can use the system and explain the agreed response and backup plans.

Use the danatech CGM Training Topic Checklist (opens in a new tab) for a fuller list of training topics.

Step 12 checklist

Set up the app or reader and account when required; insert and activate the sensor, or confirm insertion by a trained clinician for an implantable system.
Review warm-up, sensor replacement, wear site, and calibration requirements for this device; confirm the person can complete the steps they will perform.
Configure available alerts with the person and confirm how they will receive and respond to them, following the selected system’s instructions. For alert problems, see A Clinician’s Guide to Troubleshooting CGM Alerts (opens in a new tab).
Review what the displayed glucose value and trend mean and how they relate to the person’s agreed care plan. Confirm which treatment decisions this device supports. For report review, see CGM Data and Report Interpretation (opens in a new tab).
Confirm the response to low or high glucose and when to seek clinical or urgent help, using the person’s care plan. CGM does not replace symptom assessment.
Review when to use a backup blood glucose check, including symptoms that do not match readings, unavailable or suspect data, and device-specific confirmation or calibration requirements.
Review interfering substances, relevant procedures, and other limitations using current instructions for the selected device.
Review skin and adhesion care and what to do if irritation occurs.
Confirm what to do if the sensor fails or supplies are interrupted, including backup monitoring and whom to contact for replacement or clinical advice.
Agree on how data will be shared, who will review them and when, and whether the clinic monitors readings or alerts between visits. Obtain appropriate agreement.
Review the individualized sick-day and ketone-testing plan when clinically relevant. A glucose-only sensor does not measure ketones; follow specific instructions for an authorized dual glucose–ketone system.
Use teach-back or demonstration: confirm the person or care partner can obtain a reading, explain the agreed glucose or alert response, use backup monitoring, and identify whom to contact.
Arrange an early follow-up appropriate to the person’s needs to review comfort, wear, data access, understanding, and treatment decisions. Plan ongoing reviews and any coverage-required visits, including Medicare’s six-month continued-coverage visits. For coding the start and later data interpretation, see the Billing Navigator (opens in a new tab).
Provide contact details for clinical questions, device problems, and supply issues; document training, remaining support needs, and the follow-up plan.

About this tool

How should I use this workflow?

Record the access plan above the checklist, expand a step, and check work as it’s completed. Conditional tasks can be marked N/A; essential tasks can’t be excluded. A check records your confirmation of work; it doesn’t verify clinical readiness or replace the clinical record.

Who leads the work?

Roles are examples, not staffing requirements. Assign a lead locally; one person may cover several roles. A diabetes care and education specialist (DCES) or another appropriately trained healthcare professional can support education. Practice support staff and coordinators may manage logistics within local policies; prescribing, clinical decisions and education require appropriate scope and competence.

Saving and printing

Saving is off by default; without it, progress clears on reload. Saving is separate for each workflow, stays on this browser, and doesn’t sync or hand work to another team member. Printing expands every applicable step. Use the clinical record for patient information, assignments and deadlines.

Sources and scope

Scope. For outpatient initiation of personal prescription continuous glucose monitoring (CGM), including self-pay and implantable systems. Not for inpatient or professional (blinded) CGM.

American Diabetes Association. 7. Diabetes Technology: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1):S150–S165.
Centers for Medicare & Medicaid Services. Glucose Monitors, LCD L33822: initial and continued coverage.
Centers for Medicare & Medicaid Services. Discontinuing certificates of medical necessity (CMNs) and DME information forms.
U.S. Food and Drug Administration. Authorization of the first wearable device that monitors both ketones and glucose.

Abbreviations: A1C, hemoglobin A1C; AID, automated insulin delivery; CGM, continuous glucose monitoring; DCES, diabetes care and education specialist; DME, durable medical equipment; OTC, over the counter; PA, prior authorization.

Use current product labeling, clinical judgment and applicable local protocols. Record patient-specific decisions, assignments and follow-up in the clinical record. Product labeling and payer requirements can change.

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