CMS final rule moves Medicare CGMs and insulin pumps to monthly rental

On December 2, 2025, the Centers for Medicare & Medicaid Services (CMS) published its Calendar Year 2026 Home Health final rule, CMS-1828-F, in the Federal Register.[1] Beyond home health rates, the rule changes how Medicare pays for continuous glucose monitors (CGMs) and insulin infusion pumps. It puts both in a payment class called "frequent and substantial servicing" and pays for them as a bundled monthly rental.[1]

What the rule changes

Medicare's equipment rules sort durable medical equipment into payment classes. Items in the frequent and substantial servicing class are paid "on a monthly rental basis, with rental payments continuing as long as coverage of the equipment under Part B continues and the equipment is being used in the home."[1] Under that class, separate payment for supplies and accessories is not allowed.[1]

Before the rule, most Medicare beneficiaries got CGM receivers on a purchase basis, CMS wrote.[1] Under the new approach, one rental payment covers the device plus "all necessary supplies and accessories," the supplier keeps ownership of the equipment, and suppliers may bill up to three months of rental in advance.[1]

CMS gave its reasons in the rule. It said these devices change quickly and need regular software updates and technical support, and that the change "will eliminate the need to wait 5 years to replace equipment."[1] Under the rule, the contract supplier of rented equipment is responsible for updating its software.[1]

Competitive bidding and device classes

The rule ties the change to the DMEPOS Competitive Bidding Program. DMEPOS stands for durable medical equipment, prosthetics, orthotics and supplies.[1] In that program, suppliers bid in each competitive bidding area, Medicare awards contracts, and it sets a single payment amount for each item from the bids.[1] CMS wrote that class II CGMs and insulin pumps "are the highest priority category of items and services for phase in next" under the program.[1]

Class II and class III are device classes assigned by the FDA, and the rule covers CGMs in both.[1] Class III CGMs, and insulin pumps used with them, stay outside competitive bidding, but the rule classifies them the same way and pays for them with the same rental method and amounts set for class II devices.[1] Outside competitive bidding areas, CMS said fee schedule payments would use the same monthly rental amounts.[1]

The rule itself did not set a start date for the CGM and pump change. CMS wrote that it "will announce the effective date of this payment classification through program instructions."[1] The rule's other regulations took effect on January 1, 2026.[1]

The start date and the bidding timeline

In an MLN Matters article released September 30, 2026, CMS said it will pay for CGMs and insulin pumps, with their supplies and accessories, "on a bundled monthly rental basis, starting January 1, 2028."[3] The same article said Medicare will stop covering two billing codes, A4224 and A4225, on that date, because it will no longer pay for those supplies separately by the week or by the cartridge.[3] It added code A4227 for replacement supplies used with a pump the patient owns.[3]

On October 7, 2026, CMS announced dates for Round 2028 of the bidding program. The bid window had originally been scheduled to open in 2026. CMS said that "to give bidders additional time to prepare," bidder registration opens December 1, 2026, and the bid window opens January 5, 2027.[2]

What this means for you

CMS said that if you already own a CGM or insulin pump when these items are phased into competitive bidding, Medicare will keep paying separately for replacement supplies. Those payments continue only while you still own the device.[3] Under the rule, they stop once the owned equipment is replaced because it is lost, stolen, damaged beyond repair or past its useful life, or because you choose newer equipment.[1] CMS also said owners can switch to rented equipment from a contract supplier at any time.[1]

CMS said it will issue more billing guidance and post more information on the Competitive Bidding Implementation Contractor website.[3] Questions about your own device or supplies are best taken to your care team or pharmacist.