23 Miss. Code. R. 225-4.6 - Documentation

Continuous glucose monitoring (CGM) service documentation must include, but is not limited to:

A. The beneficiary and/or care giver is capable of operating the continuous glucose monitoring system,

B. The beneficiary:

1. Has an established diagnosis of type I or type II diabetes mellitus that is poorly controlled as defined in Miss. Admin. Code Part 225, Rule 4.3.A.1.a),

2. Requires three (3) insulin injections per day, or use of an insulin pump, for maintenance of blood glucose control,

3. Requires regular self-monitoring of at least four (4) times a day,

4. Requires frequent adjustment to insulin treatment regimen based on blood glucose testing results,

5. Had an in-person visit with the ordering physician within six (6) months prior to ordering to evaluate their diabetes control and determined that criteria (1-4) above are met,

6. Has an in-person visit every six (6) months following the prescription of the CGM to assess adherence to the CGM regimen and diabetes treatment plan.

C. The CGM is a Food and Drug Administration (FDA) approved medical device and is capable of accurately measuring and transmitting beneficiary blood data.

Notes

23 Miss. Code. R. 225-4.6

42 U.S.C. § 1395 x(n); Miss. Code Ann. §§ 43-13-117, 43-13-121, 83-9-353.

Adopted 7/1/2015 Amended 10/1/2023