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.
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.
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.
|Codes that will require prior authorization||Devices|
||Dexcom, Eversense, Libre, Medtronic|
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.