CG-DME-51 External Insulin Pumps

This policy addresses coverage for external insulin infusion pumps (disposable or durable). They are covered when the individual has documented diabetes mellitus (any type), the individual/caregiver has completed a comprehensive diabetes education program, requires multiple daily insulin injections, and is performing multiple daily blood glucose tests or using a continuous glucose monitor; they are not covered if these criteria are not met, for continued use when ongoing criteria are not maintained, or for replacement/upgrade of a functional, in‑warranty pump solely for additional features.

"External insulin pumps (either disposable or durable) are consideredmedically necessarywhen the following criteria are met:"

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