Glucose Monitors - DME.GC.100.A
EVICORE-DME-FD90ECBC
Home BGMs (E0607), specialty BGMs (E2100/E2101), CGMs and related supplies (E2102/E2103/E2104, A4238/A4239/A4271/A9276–A9278 and related supply codes) are covered when medically necessary, while disposable home-only monitors/test strips (A9275), certain convenience devices (e.g., non‑wireless wearable insulin devices), non‑home glucose monitors, urine strips, listed antiseptics, and a laser skin‑piercing device (E0620) are excluded or considered experimental. Coverage requires documentation of diabetes and device training for BGMs, additional documentation for severe visual or manual dexterity impairments for specialty BGMs, and for CGMs adults must have diabetes plus insulin use or hypoglycemia history or HbA1c >7% or participation in a diabetes program (gestational/pediatric CGM have insulin/use and safety criteria); supplies are limited to one unit per 30 days, strip/lancet quantities depend on insulin status, non‑adjunctive CGMs replace standard BGMs (you cannot bill both), and the FDA cautions against non‑adjunctive CGM use in dialysis or critically ill patients.