External Insulin Infusion Pumps - DME.GC.101.A

External external insulin infusion pumps and their associated supplies are covered when medically necessary, while implanted infusion pumps (E0782/E0785/E0786) and disposable external pumps (e.g., OmniPod, V‑Go; HCPCS A9274) are excluded. Coverage requires type 1 or type 2 diabetes with insulin use (MDI or continuous), documented glucose monitoring ≥4 times/day or use of a CGM, documentation of at least one qualifying clinical finding (e.g., HbA1c >7%, fasting AM glucose >200 mg/dL, frequent hypoglycemia <70 mg/dL, difficult-to-control or problematic glucose levels, or participation in a diabetes management program), verification of device FDA age approval, and any applicable prior-authorization/coverage rules.

"The individual has type 1 or type 2 diabetes mellitus."

Sign up to see full coverage criteria, indications, and limitations.