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Continuous glucose monitoring device coverage starting January 1
November 22, 2019

This article is for:
  • Endocrinologists, pediatricians, and primary care providers who order continuous glucose monitoring devices for our members
  • Durable medical equipment providers who supply the devices

In our monthly news article notifying you of upcoming medical policy changes, we listed an update to our Continuous Intermittent Monitoring of Glucose in Interstitial Fluid and Artificial Pancreas Device Systems medical policy 107. Now, we’d like to provide more details on the coverage changes we’re making that take effect on January 1, 2020.

CGM device coverage

We’re expanding coverage of continuous glucose monitoring (CGM) devices to commercial HMO/POS and Medicare HMO Blue members who have type II diabetes and meet the criteria listed in our policy.

CGM devices will require prior authorization for new starts or new devices

For our commercial HMO/POS and Medicare HMO Blue members with type I or type II diabetes, the codes for the CGM devices listed below will require prior authorization.

  • Prior authorization is required only for new starts on the device or for existing members who need a new device. (Sensors and transmitters don’t require prior authorization).
  • You can find the form to request prior authorization at the end of the medical policy.
Codes that will require prior authorization Devices
  • A9277
  • K0553
  • S1036
Dexcom, Eversense, Libre, Medtronic

Durable medical equipment providers

Please check to make sure there’s an authorization in place for the device to avoid rejected claims.

In addition, please remember that an approved authorization on file for the CGM device does not include coverage for the sensor (A9276) component of the device. The member still needs to have either pharmacy coverage, or a benefit rider attached to their medical coverage with Blue Cross, in order for any claim submitted for the sensor (A9276) component to process for payment.

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