23 Miss. Code. R. 209-1.26 - Glucose Monitoring Devices
A. The Division of
Medicaid defines glucose monitoring devices as durable medical equipment (DME)
for home use to measure glucose levels which includes a:
1. Blood glucose monitor (BGM) defined as a
portable battery-operated meter used to determine the beneficiary's blood
glucose level by exposing a reagent strip to a small blood sample resulting in
the strip's colorimetric reaction to glucose concentrations, and
2. Continuous glucose monitoring (CGM)
defined as DME used to detect trends and patterns in the beneficiary's glucose
levels in the interstitial or intracellular fluid. There are two types of CGMs:
a) An adjunctive CGM requires the user verify
their glucose levels or trends displayed on a CGM with a BGM prior to making
treatment decisions. The glucose levels are recorded by an external recorder
that stores the data until it is downloaded for review or sent via a
transmitter to an external monitor for beneficiary interaction.
b) A non-adjunctive CGM can be used to make
treatment decisions without the need for a stand-alone BGM to confirm testing
results. These readings are intended to take the place of the information
obtained from beneficiary self-monitoring of blood glucose via a BGM.
B. The Division of
Medicaid covers a BGM for rental up to amount of purchase, or purchase when
prior authorized by the Utilization Management and Quality Improvement
Organization (UM/QIO), the Division of Medicaid or designated entity and
ordered by a physician when all the following are criteria are met [Refer to
Miss. Admin. Code Part 209, Chapter 2: Medical Supplies, Rule
2.2.C.1 for Blood Glucose Monitor
(BGM) and Rule 2.2.C.2 for
Continuous Glucose Monitor (CGM)]:
1. The
beneficiary has one (1) of the following diagnoses:
a) Type I diabetes mellitus,
b) Type II diabetes mellitus, or
1) With a documented history of blood glucose
fluctuating outside the normal range as specified by the physician,
2) Requiring oral diabetes medication,
and
3) Requiring a prescribed
specialized diet.
c)
Gestational diabetes mellitus requiring treatment.
2. The medical record contains documentation
that the beneficiary or caregiver is able to demonstrate the ability to
accurately perform the blood glucose testing and accurately report the
results.
3. The blood glucose
monitor is specifically designed for home use rather than clinical
use.
C. The Division of
Medicaid covers a minimally invasive CGM for rental up to amount of purchase,
or purchase when indicated, when approved by the Federal Drug Administration
(FDA) as a medical device for home use, medically necessary, prior authorized
by the Utilization Management/Quality Improvement Organization (UM/QIO), the
Division of Medicaid or designated entity, ordered by the physician who is
actively managing the beneficiary's diabetes and the beneficiary meets all of
the criteria outlined in Miss. Admin. Code, Part 225, Rule 4.3.
D. The CGM device must be a Food and Drug
Administration (FDA) approved medical device and be capable of accurately
measuring and transmitting beneficiary blood data. Refer to Miss. Admin. Code
Part 225, Chapter 4: Continuous Glucose Monitoring Services.
Notes
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