Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes – Commercial and Individual Exchange Medical Policy

This policy covers continuous glucose monitoring (CGM) and insulin delivery systems for patients with diabetes who meet specific clinical criteria, requiring prior authorization for long-term CGM use. Coverage also extends to durable medical equipment and orthotics deemed necessary by a licensed provider, while short-term CGM use for diagnostics is considered medically necessary. Limitations include non-coverage for individuals without a diabetes diagnosis, restrictions on certain equipment based on necessity, and the requirement for clinical documentation to support medical necessity.

"Continuous glucose monitoring is covered for patients with diabetes who meet specific clinical criteria."

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