CG-LAB-30 Outpatient Laboratory-based Blood Glucose Testing

This policy addresses outpatient laboratory-based blood glucose testing. It is covered (medically necessary) when members meet defined clinical criteria (A–Q), including signs or symptoms of hypoglycemia or hyperglycemia or overweight/obesity at any age; it is not covered when these criteria are not met or for any other indications.

"Blood glucose testing is consideredmedically necessaryfor individuals who meet any of the following criteria (A through Q):"

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