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

UnitedHealthcare covers FDA‑labeled external insulin pumps and short‑term (3–14 day) professional CGM, and will cover long‑term non‑implantable and implantable CGM (implantables only for age ≥18) when InterQual medical‑necessity criteria are met, while classifying implantable insulin pumps, nonprogrammable transdermal systems (e.g., V‑Go), and noninvasive CGMs as unproven/not medically necessary (OTC CGMs may be excluded by plan). Key requirements: devices must be used per FDA labeling and InterQual CP with supporting documentation (e.g., insulin ≥3×/day or qualifying level 2–3 hypoglycemia with failed treatment adjustments), initial CGM authorization up to 6 months (reauthorize up to 12), and six‑monthly provider adherence assessments for continued coverage.

"External continuous subcutaneous insulin infusion pumps are proven and medically necessary in certain circumstances when used according to U."