CG-DME-42 Continuous Glucose Monitoring Devices

This policy addresses continuous interstitial glucose monitoring (CGM) devices, specifically non-implanted CGMs for personal use. Coverage is medically necessary for individuals with any type of diabetes who use multiple daily insulin injections or an insulin pump, can appropriately use the device and remain engaged in a comprehensive diabetes care plan, and who have ongoing control issues despite optimized management (e.g., HbA1c above target or persistent fasting hypoglycemia). Use, continued use, or replacement of CGMs is not medically necessary when the applicable criteria are not met.

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