Individuals with Type 1 Diabetes
Long-term continuous glucose monitoring (CGM) device monitoring of glucose levels in interstitial fluid, as a technique of diabetic monitoring, may be considered medically necessary in individuals with type 1 diabetes who have demonstrated an understanding of the technology, are motivated to use the device correctly and consistently, are expected to adhere to a comprehensive diabetes treatment plan supervised by a qualified provider, and are capable of using the device to recognize alerts and alarms
Short-term CGM monitoring of glucose levels in interstitial fluid may be considered medically necessary in individuals with type 1 diabetes whose diabetes is poorly controlled, despite current use of best practices (see Policy Guidelines section). Poorly controlled type 1 diabetes includes the following clinical situations: unexplained hypoglycemic episodes, hypoglycemic unawareness, suspected postprandial hyperglycemia, and recurrent diabetic ketoacidosis.
Short-term CGM monitoring of glucose levels in interstitial fluid may also be considered medically necessary in patients with type 1 diabetes prior to insulin pump initiation to determine basal insulin levels.
Individuals with Type 2 Diabetes
Long-term CGM monitoring of glucose levels in interstitial fluid may be considered medically necessary in individuals with type 2 diabetes who are willing and able to use the device and have adequate medical supervision and who experience significant hypoglycemia on multiple daily doses of insulin or an insulin pump in the setting of insulin deficiency.
Short-term and long-term CGM monitoring of glucose levels in interstitial fluid may be considered medically necessary in individuals with type 2 diabetes who require multiple daily doses of insulin and whose diabetes is poorly controlled, despite current use of best practices (see Policy Guidelines section) and are capable of using devices safely. Poorly controlled type 2 diabetes includes the following clinical situations: unexplained hypoglycemic episodes, hypoglycemic unawareness, persistent hyperglycemia, or hemoglobin A1c (HbA1c) levels above target.
Short-term CGM monitoring of glucose levels in interstitial fluid may be considered medically necessary in individuals with type 2 diabetes who require multiple daily doses of insulin to determine basal insulin levels prior to insulin pump initiation.
Short-term and long-term CGM monitoring of glucose levels in interstitial fluid in individuals with type 2 diabetes not on intensive insulin therapy (i.e., individuals on basal insulin or oral antidiabetic agents only) is considered investigational.
Other uses of long-term and short-term CGM monitoring of glucose levels in interstitial fluid as a technique of diabetic monitoring including use in gestational diabetes are considered investigational.
The use of implantable CGM devices for management of Type 1 and Type 2 diabetes mellitus is considered investigational.
