Continuous Glucose Monitor (CGM) for pediatric diabetes
Defines medical necessity criteria, indications, contraindications, supply allowances, and utilization management procedures for CGM devices (CPT/HCPCS A9276, A9277, A9278 / K0553, K0554 referenced) for pediatric members with diabetes in the Georgia Region.
Reviewed/Revised on 3/14/2025 with no explicit material change noted in document.
Coverage Summary
This policy defines medical necessity criteria for continuous glucose monitoring (CGM) in pediatric members with diabetes and is classified as covered_with_criteria. It focuses on CGM device coverage (HCPCS A9276, A9277, A9278; K0553, K0554 referenced) for patients under 18 years managed by pediatric endocrinology.
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