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Aetna has Changed Their Clinical Policies Bulletin on CGMS!!!

Discussion in 'Insurance Issues' started by Marcy, Jun 20, 2008.

  1. Marcy

    Marcy Approved members

    Joined:
    Jun 10, 2008
    Messages:
    5
    Here is the new policy:

    Continuous Glucose Monitoring Devices:

    Aetna considers continuous glucose monitoring devices (e.g., MiniMed Continuous Glucose Monitoring System, Guardian Real-Time Continuous Glucose Monitoring System, and the DexCom STS), which are used to continuously monitor diabetic persons' blood glucose levels over a three-day (72-hour) period, medically necessary for persons with type 1 diabetes who have either of the following problems in controlling blood glucose level, unresponsive to conventional insulin dose adjustment:

    repeated hypo- and hyperglycemia at the same time each day; or
    hypoglycemia unawareness.

    No more than two CGMS monitoring periods are considered medically necessary within a 12-month period.

    Aetna considers the long-term use of continuous glucose monitoring devices medically necessary as an adjunct to fingerstick testing of blood glucose in persons with type 1 diabetes who have had recurrent episodes of severe hypoglycemia (blood glucose less than 50mg/dL) despite appropriate modifications in insulin regimen and compliance with frequent self-monitoring (at least four fingersticks per day). Long-term use of continuous glucose monitoring devices are considered experimental and investigational for all other indications. Note: For long-term use for recurrent hypoglycemia, the CGMS monitor must be used by the member on a trial basis for a minimum of one month (30 days), but not to exceed two months. The trial period will be paid as a rental. The trial period must be monitored by the physician to determine the effectiveness of the CGMS monitor. For coverage of a purchase, the physician must determine that the member is likely to derive significant therapeutic benefit from continuous use of CGMS over a long period of time. The physician's records must document a reevaluation of the member at the end of the trial period, must indicate compliance with the use of the CGMS monitor, and the results of the use.
     
  2. Mama2H

    Mama2H Approved members

    Joined:
    Oct 19, 2006
    Messages:
    4,236
    That is awesome news!!!!!!!!!!!!!! I hope this is a trend that continues!!!!!
     
  3. BrendaK

    BrendaK Neonatal Diabetes Registry

    Joined:
    Oct 29, 2005
    Messages:
    3,835
    It's about time they changed the wording on their policy! Thanks SO MUCH for posting this. We have Aetna and I feel like we can move forward, if we choose, with the CGMS. Hmmmm....Carson hasn't had many under 50 lately, though. As soon as he does, I'll have to download the meter and sent it to Aetna ;)
     

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