Aetna · Clinical coverage policy

Aetna Diabetes Tests, Programs and Supplies coverage criteria

Aetna CPB 0070 covers routine diabetes supplies (meters, strips, lancets, insulin pens/syringes, control solutions), physician-ordered diabetes self-management programs, GAD autoantibody testing in defined situations, jet injectors and specialized/alternate-site/visually-impaired meters for members with a specific functional need, and continuous glucose monitors — short-term diagnostic use for hypoglycemia/neonatal hypoglycemia disorders, and long-term therapeutic use mainly for diabetes patients on an intensive insulin regimen who are under 18, not meeting glycemic targets, or having hypoglycemia (plus glycogen storage disease). Long-term CGM is considered experimental for other uses (including gestational diabetes and non-intensive type 2 diabetes), and a long list of devices/tests (laser monitors, fructosamine, home A1c monitors, diabetes apps, remote-monitoring add-ons, etc.) are non-covered as experimental or convenience items.

Policy CPB 0070 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0070

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0070 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Diabetes Tests, Programs and Supplies (CPT 82947), and what gets it denied?

Path
Aetna CPB 0070 covers routine diabetes supplies (meters, strips, lancets, insulin pens/syringes, control solutions), physician-ordered diabetes self-management programs, GAD autoantibody testing in defined situations, jet injectors and specialized/alternate-site/visually-impaired meters for members with a specific functional need, and continuous glucose monitors — short-term diagnostic use for hypoglycemia/neonatal hypoglycemia disorders, and long-term therapeutic use mainly for diabetes patients on an intensive insulin regimen who are under 18, not meeting glycemic targets, or having hypoglycemia (plus glycogen storage disease). Long-term CGM is considered experimental for other uses (including gestational diabetes and non-intensive type 2 diabetes), and a long list of devices/tests (laser monitors, fructosamine, home A1c monitors, diabetes apps, remote-monitoring add-ons, etc.) are non-covered as experimental or convenience items. Coverage criteria include: Diabetes self-care / outpatient diabetes self-management programs are medically necessary when meeting ALL of: (1) the program consists of services of recognized healthcare professionals (e.g., physicians, registered dieticians, registered nurses, registered pharmacists); (2) the program is designed to educate the member about medically necessary diabetes self-care; AND (3) the program is ordered by the physician treating the member's diabetes and includes a statement signed by the physician that the service is needed.; Diabetic supplies are covered, including: alcohol swabs; blood glucose monitors; blood glucose test strips; control solutions; insulin pens; lancets; needles and syringes for insulin administration; and urine test tablets/strips. (Note: generally covered under a pharmacy/diabetic-supplies rider rather than medical coverage, except for Medicare plans or where mandated by state law; check plan benefits.); Measurement of autoantibodies to glutamic acid decarboxylase (GAD) is covered for distinguishing type 1 from type 2 diabetes when the clinical history is ambiguous AND the results of testing will influence patient management.; Measurement of anti-GAD antibodies is covered in diagnosing stiff-person syndrome.; Jet injectors are covered as DME when the member or the member's caregiver is physically unable to use a conventional needle-syringe.; Short-term diagnostic CGM (72 hours to 1 week) is covered for hypoglycemia management in members with diabetes meeting ONE of: (a) hypoglycemia unawareness; OR (b) repeated hypoglycemia (less than 50 mg/dL) and hyperglycemia (greater than 150 mg/dL) at the same time each day — AND in either case the condition is unresponsive to conventional insulin dose adjustment.; Short-term diagnostic CGM (72 hours to 1 week) is covered to diagnose primary islet cell hypertrophy (nesidioblastosis) or persistent hyperinsulinemic hypoglycemia of infancy (PHHI) (congenital hypoglycemia) in members with symptoms suggestive of recurrent hypoglycemia.; Short-term diagnostic CGM frequency limit: no more than 2 continuous glucose monitoring periods within a 12-month period.; Long-term therapeutic CGM (greater than 1 week) — INITIAL approval, diabetes pathway: member has a diagnosis of diabetes mellitus (type 1 or type 2) AND meets ALL of: (1) the member is using an intensive insulin regimen (defined as multiple daily injections [3 or more injections per day] or insulin pump therapy); AND (2) ONE of: the member is less than 18 years of age OR the member is not meeting glycemic targets OR the member is experiencing hypoglycemia (including hypoglycemia unawareness).; Long-term therapeutic CGM (greater than 1 week) — INITIAL approval, alternate pathway: member has a diagnosis of glycogen storage disease.; Long-term therapeutic CGM — CONTINUATION of therapy for diabetes members: member meets ALL of: (1) the member is using an intensive insulin regimen (multiple daily injections [3 or more injections per day] or insulin pump therapy); AND (2) ONE of: the member has experienced improved glycemic control or decreased hypoglycemia episodes while using a CGM OR the member is being assessed every 6 months by the prescriber for adherence to their CGM regimen and diabetes treatment plan.; Long-term therapeutic CGM — CONTINUATION for glycogen storage disease: all members (including new members) with a diagnosis of glycogen storage disease meet all initial criteria (i.e., continuation requires meeting the initial glycogen storage disease criterion).; Blood glucose meters for the visually impaired (reflectance meters with an electronic voice, automatic timers, and specially designed arrangements of supplies and materials allowing use without assistance) are covered as DME for legally blind members with diabetes (best corrected visual acuity less than 20/200).; Blood glucose monitors with integrated lancing/blood sample are covered as DME when the member meets ONE of: (a) legally blind (best corrected visual acuity less than 20/200); OR (b) impairment of manual dexterity severe enough to require the use of this special monitoring system.; Alternate site blood glucose monitors are covered as DME, when recommended by the member's physician, for members meeting ONE of: (a) children below age 12 years; OR (b) members who have used conventional blood glucose meters for at least 1 month (more than 30 days) and have been non-compliant with blood glucose testing because of pain sensitivity or heavily callused fingertips.; A disposable blood glucose monitor (e.g., ReliOn NewTek) is an acceptable alternative to a standard blood glucose monitor.; Intermittently scanned 'flash' continuous glucose monitoring systems (FreeStyle Libre Flash Glucose Monitoring System) are an equally acceptable alternative to other CGM systems for medically necessary indications.; Continuous glucose monitors with implantable glucose sensors (e.g., Eversense E3 implantable CGM sensor) are an equally acceptable alternative to standard CGMs for medically necessary indications.; CGM supplies/sensors/transmitters/receivers are covered when the CGM device itself meets the medically necessary long-term therapeutic criteria.; Artificial pancreas device systems and insulin infusion pumps are addressed by cross-reference (see CPB 0161 Infusion Pumps; CPB 0742 Intermittent Intravenous Insulin Therapy) — criteria governed by those bulletins.. Applies to 54 codes: 82947, 82948, 82950, 82962, 95249, 95250, 95251, 97802, 97803, 97804, A4206, A4207, A4208, A4209, A4210, A4211, A4212, A4213, A4215, A4216, A4217, A4220, A4223, A4224, A4225, A4226, A4227, A4228, A4230, A4231, A4232, A4233, A4234, A4235, A4236, A4238, A4244, A4245, A4246, A4247, A4248, A4250, A4253, A4254, A4255, A4256, A4257, A4258, A4259, E0607, E2100, E2101, G0108, G0109.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. The bulletin references that for Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification. It does not state a universal precertification requirement or process for all covered items in this policy. Documentation: For diabetes self-care programs: the program must be ordered by the physician treating the member's diabetes and must include a statement signed by the physician that the service is needed.; For specialty pharmacy items, a Statement of Medical Necessity (SMN) precertification form may be required (see Specialty Pharmacy Precertification).
Trap
Policy exclusions and limitations: Anti-GAD antibody measurement is considered experimental, investigational, or unproven for predicting the onset of diabetes and for all other indications (other than distinguishing type 1 from type 2 diabetes when clinical history is ambiguous, or diagnosing stiff-person syndrome).; Use of jet injectors for reasons other than the member/caregiver being physically unable to use a conventional needle-syringe is considered a matter of preference and convenience (not covered).; Long-term therapeutic use of a CGM device is considered experimental, investigational, or unproven for all other indications, including (not all-inclusive): gestational diabetes; member with type 2 diabetes not using intensive insulin regimens; monitoring blood glucose in non-diabetic members following gastric bypass surgery; neonatal hypoglycemia; and nesidioblastosis (primary islet cell hypertrophy).; Alternate site blood glucose monitors have no proven value over standard blood glucose monitors for indications other than the two covered indications (not covered for other indications).; The I-Port Injection Port (Patton Medical) is considered a non-covered convenience item.; Combination devices that include a home blood glucose monitor combined with a blood pressure monitor, cholesterol screening analyzer, or other devices (e.g., cellular telephone) not specifically indicated for the management of diabetes mellitus are considered not medically necessary convenience items.; Hypoglycemic wristband alarms (e.g., Sleep Sentry) are a noncovered convenience item.; A feature allowing wireless transmission of blood glucose test results (cellular-enabled glucometer) is considered an integral part of the glucometer and is not separately reimbursed.; Computer software for analyzing blood glucose monitor test results is considered an integral part of a blood glucose monitor and is not separately reimbursed.; Lasette Laser Blood Glucose Monitoring Device is experimental/investigational/unproven — insufficient evidence that laser skin perforation offers clinically significant advantages over standard lancets.; Glycated serum proteins (fructosamine) measurement (e.g., Duet Glucose Control System by LXN Corporation) is experimental/investigational/unproven — clinical utility has not been established.; PreDx Test is experimental/investigational/unproven — inadequate evidence in the published peer-reviewed clinical literature regarding its effectiveness.; GlucoWatch Biographer Monitor is experimental/investigational/unproven.; Home glycated hemoglobin (HbA1c/A1C) monitors (e.g., A1cNow Diabetes Monitor) are experimental/investigational/unproven — no prospective clinical studies demonstrating improvements in compliance or other clinically significant benefits over laboratory A1C testing (individual-case exceptions may be made on medical review for members unable to access laboratory A1C testing).; Mobile application software for self-management of diabetes (e.g., BlueStar, d-Nav) is considered experimental, investigational, or unproven because its effectiveness has not been established.; Personal digital assistant-based blood glucose monitors are experimental/investigational/unproven — not shown in published clinical studies to improve clinical outcomes over standard blood glucose monitors.; Infrared thermometer device for intermittent measurement/monitoring of skin surface temperature (e.g., TempTouch) is experimental/investigational/unproven for reducing the risk of diabetic foot ulceration — insufficient evidence.; Measurement of advanced glycation end products by skin autofluorescence is experimental/investigational/unproven — insufficient evidence of effectiveness compared to the oral glucose tolerance test.; Remote/remote wireless glucose monitoring devices (e.g., mySentry) are experimental/investigational/unproven — insufficient published evidence of impact on clinical outcomes.; An attachment to allow wireless transmission from a continuous glucose monitor to a smart phone or computer (e.g., MiniMed Connect) is not covered because it is considered a convenience feature.; No additional reimbursement is provided for a wireless transmission feature integrated into a continuous glucose monitor (e.g., Dexcom SHARE) because it is considered a convenience feature.; Cellular activation therapy (e.g., Bionica Microdose infusion pump) is experimental/investigational/unproven.; Skin microvascular flow-motion is experimental/investigational/unproven.; Kihealth Diabetes Risk Test is experimental/investigational/unproven. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0070 — Diabetes Tests, Programs and Supplies

Coverage criteria

  • Diabetes self-care / outpatient diabetes self-management programs are medically necessary when meeting ALL of: (1) the program consists of services of recognized healthcare professionals (e.g., physicians, registered dieticians, registered nurses, registered pharmacists); (2) the program is designed to educate the member about medically necessary diabetes self-care; AND (3) the program is ordered by the physician treating the member's diabetes and includes a statement signed by the physician that the service is needed.
  • Diabetic supplies are covered, including: alcohol swabs; blood glucose monitors; blood glucose test strips; control solutions; insulin pens; lancets; needles and syringes for insulin administration; and urine test tablets/strips. (Note: generally covered under a pharmacy/diabetic-supplies rider rather than medical coverage, except for Medicare plans or where mandated by state law; check plan benefits.)
  • Measurement of autoantibodies to glutamic acid decarboxylase (GAD) is covered for distinguishing type 1 from type 2 diabetes when the clinical history is ambiguous AND the results of testing will influence patient management.
  • Measurement of anti-GAD antibodies is covered in diagnosing stiff-person syndrome.
  • Jet injectors are covered as DME when the member or the member's caregiver is physically unable to use a conventional needle-syringe.
  • Short-term diagnostic CGM (72 hours to 1 week) is covered for hypoglycemia management in members with diabetes meeting ONE of: (a) hypoglycemia unawareness; OR (b) repeated hypoglycemia (less than 50 mg/dL) and hyperglycemia (greater than 150 mg/dL) at the same time each day — AND in either case the condition is unresponsive to conventional insulin dose adjustment.
  • Short-term diagnostic CGM (72 hours to 1 week) is covered to diagnose primary islet cell hypertrophy (nesidioblastosis) or persistent hyperinsulinemic hypoglycemia of infancy (PHHI) (congenital hypoglycemia) in members with symptoms suggestive of recurrent hypoglycemia.
  • Short-term diagnostic CGM frequency limit: no more than 2 continuous glucose monitoring periods within a 12-month period.
  • Long-term therapeutic CGM (greater than 1 week) — INITIAL approval, diabetes pathway: member has a diagnosis of diabetes mellitus (type 1 or type 2) AND meets ALL of: (1) the member is using an intensive insulin regimen (defined as multiple daily injections [3 or more injections per day] or insulin pump therapy); AND (2) ONE of: the member is less than 18 years of age OR the member is not meeting glycemic targets OR the member is experiencing hypoglycemia (including hypoglycemia unawareness).
  • Long-term therapeutic CGM (greater than 1 week) — INITIAL approval, alternate pathway: member has a diagnosis of glycogen storage disease.
  • Long-term therapeutic CGM — CONTINUATION of therapy for diabetes members: member meets ALL of: (1) the member is using an intensive insulin regimen (multiple daily injections [3 or more injections per day] or insulin pump therapy); AND (2) ONE of: the member has experienced improved glycemic control or decreased hypoglycemia episodes while using a CGM OR the member is being assessed every 6 months by the prescriber for adherence to their CGM regimen and diabetes treatment plan.
  • Long-term therapeutic CGM — CONTINUATION for glycogen storage disease: all members (including new members) with a diagnosis of glycogen storage disease meet all initial criteria (i.e., continuation requires meeting the initial glycogen storage disease criterion).
  • Blood glucose meters for the visually impaired (reflectance meters with an electronic voice, automatic timers, and specially designed arrangements of supplies and materials allowing use without assistance) are covered as DME for legally blind members with diabetes (best corrected visual acuity less than 20/200).
  • Blood glucose monitors with integrated lancing/blood sample are covered as DME when the member meets ONE of: (a) legally blind (best corrected visual acuity less than 20/200); OR (b) impairment of manual dexterity severe enough to require the use of this special monitoring system.
  • Alternate site blood glucose monitors are covered as DME, when recommended by the member's physician, for members meeting ONE of: (a) children below age 12 years; OR (b) members who have used conventional blood glucose meters for at least 1 month (more than 30 days) and have been non-compliant with blood glucose testing because of pain sensitivity or heavily callused fingertips.
  • A disposable blood glucose monitor (e.g., ReliOn NewTek) is an acceptable alternative to a standard blood glucose monitor.
  • Intermittently scanned 'flash' continuous glucose monitoring systems (FreeStyle Libre Flash Glucose Monitoring System) are an equally acceptable alternative to other CGM systems for medically necessary indications.
  • Continuous glucose monitors with implantable glucose sensors (e.g., Eversense E3 implantable CGM sensor) are an equally acceptable alternative to standard CGMs for medically necessary indications.
  • CGM supplies/sensors/transmitters/receivers are covered when the CGM device itself meets the medically necessary long-term therapeutic criteria.
  • Artificial pancreas device systems and insulin infusion pumps are addressed by cross-reference (see CPB 0161 Infusion Pumps; CPB 0742 Intermittent Intravenous Insulin Therapy) — criteria governed by those bulletins.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Documentation required

  • For diabetes self-care programs: the program must be ordered by the physician treating the member's diabetes and must include a statement signed by the physician that the service is needed.
  • For specialty pharmacy items, a Statement of Medical Necessity (SMN) precertification form may be required (see Specialty Pharmacy Precertification).

Frequently asked questions

When does Aetna cover Diabetes Tests, Programs and Supplies (CPT 82947), and what gets it denied?
Aetna CPB 0070 covers routine diabetes supplies (meters, strips, lancets, insulin pens/syringes, control solutions), physician-ordered diabetes self-management programs, GAD autoantibody testing in defined situations, jet injectors and specialized/alternate-site/visually-impaired meters for members with a specific functional need, and continuous glucose monitors — short-term diagnostic use for hypoglycemia/neonatal hypoglycemia disorders, and long-term therapeutic use mainly for diabetes patients on an intensive insulin regimen who are under 18, not meeting glycemic targets, or having hypoglycemia (plus glycogen storage disease). Long-term CGM is considered experimental for other uses (including gestational diabetes and non-intensive type 2 diabetes), and a long list of devices/tests (laser monitors, fructosamine, home A1c monitors, diabetes apps, remote-monitoring add-ons, etc.) are non-covered as experimental or convenience items. Coverage criteria include: Diabetes self-care / outpatient diabetes self-management programs are medically necessary when meeting ALL of: (1) the program consists of services of recognized healthcare professionals (e.g., physicians, registered dieticians, registered nurses, registered pharmacists); (2) the program is designed to educate the member about medically necessary diabetes self-care; AND (3) the program is ordered by the physician treating the member's diabetes and includes a statement signed by the physician that the service is needed.; Diabetic supplies are covered, including: alcohol swabs; blood glucose monitors; blood glucose test strips; control solutions; insulin pens; lancets; needles and syringes for insulin administration; and urine test tablets/strips. (Note: generally covered under a pharmacy/diabetic-supplies rider rather than medical coverage, except for Medicare plans or where mandated by state law; check plan benefits.); Measurement of autoantibodies to glutamic acid decarboxylase (GAD) is covered for distinguishing type 1 from type 2 diabetes when the clinical history is ambiguous AND the results of testing will influence patient management.; Measurement of anti-GAD antibodies is covered in diagnosing stiff-person syndrome.; Jet injectors are covered as DME when the member or the member's caregiver is physically unable to use a conventional needle-syringe.; Short-term diagnostic CGM (72 hours to 1 week) is covered for hypoglycemia management in members with diabetes meeting ONE of: (a) hypoglycemia unawareness; OR (b) repeated hypoglycemia (less than 50 mg/dL) and hyperglycemia (greater than 150 mg/dL) at the same time each day — AND in either case the condition is unresponsive to conventional insulin dose adjustment.; Short-term diagnostic CGM (72 hours to 1 week) is covered to diagnose primary islet cell hypertrophy (nesidioblastosis) or persistent hyperinsulinemic hypoglycemia of infancy (PHHI) (congenital hypoglycemia) in members with symptoms suggestive of recurrent hypoglycemia.; Short-term diagnostic CGM frequency limit: no more than 2 continuous glucose monitoring periods within a 12-month period.; Long-term therapeutic CGM (greater than 1 week) — INITIAL approval, diabetes pathway: member has a diagnosis of diabetes mellitus (type 1 or type 2) AND meets ALL of: (1) the member is using an intensive insulin regimen (defined as multiple daily injections [3 or more injections per day] or insulin pump therapy); AND (2) ONE of: the member is less than 18 years of age OR the member is not meeting glycemic targets OR the member is experiencing hypoglycemia (including hypoglycemia unawareness).; Long-term therapeutic CGM (greater than 1 week) — INITIAL approval, alternate pathway: member has a diagnosis of glycogen storage disease.; Long-term therapeutic CGM — CONTINUATION of therapy for diabetes members: member meets ALL of: (1) the member is using an intensive insulin regimen (multiple daily injections [3 or more injections per day] or insulin pump therapy); AND (2) ONE of: the member has experienced improved glycemic control or decreased hypoglycemia episodes while using a CGM OR the member is being assessed every 6 months by the prescriber for adherence to their CGM regimen and diabetes treatment plan.; Long-term therapeutic CGM — CONTINUATION for glycogen storage disease: all members (including new members) with a diagnosis of glycogen storage disease meet all initial criteria (i.e., continuation requires meeting the initial glycogen storage disease criterion).; Blood glucose meters for the visually impaired (reflectance meters with an electronic voice, automatic timers, and specially designed arrangements of supplies and materials allowing use without assistance) are covered as DME for legally blind members with diabetes (best corrected visual acuity less than 20/200).; Blood glucose monitors with integrated lancing/blood sample are covered as DME when the member meets ONE of: (a) legally blind (best corrected visual acuity less than 20/200); OR (b) impairment of manual dexterity severe enough to require the use of this special monitoring system.; Alternate site blood glucose monitors are covered as DME, when recommended by the member's physician, for members meeting ONE of: (a) children below age 12 years; OR (b) members who have used conventional blood glucose meters for at least 1 month (more than 30 days) and have been non-compliant with blood glucose testing because of pain sensitivity or heavily callused fingertips.; A disposable blood glucose monitor (e.g., ReliOn NewTek) is an acceptable alternative to a standard blood glucose monitor.; Intermittently scanned 'flash' continuous glucose monitoring systems (FreeStyle Libre Flash Glucose Monitoring System) are an equally acceptable alternative to other CGM systems for medically necessary indications.; Continuous glucose monitors with implantable glucose sensors (e.g., Eversense E3 implantable CGM sensor) are an equally acceptable alternative to standard CGMs for medically necessary indications.; CGM supplies/sensors/transmitters/receivers are covered when the CGM device itself meets the medically necessary long-term therapeutic criteria.; Artificial pancreas device systems and insulin infusion pumps are addressed by cross-reference (see CPB 0161 Infusion Pumps; CPB 0742 Intermittent Intravenous Insulin Therapy) — criteria governed by those bulletins.. Applies to 54 codes: 82947, 82948, 82950, 82962, 95249, 95250, 95251, 97802, 97803, 97804, A4206, A4207, A4208, A4209, A4210, A4211, A4212, A4213, A4215, A4216, A4217, A4220, A4223, A4224, A4225, A4226, A4227, A4228, A4230, A4231, A4232, A4233, A4234, A4235, A4236, A4238, A4244, A4245, A4246, A4247, A4248, A4250, A4253, A4254, A4255, A4256, A4257, A4258, A4259, E0607, E2100, E2101, G0108, G0109. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. The bulletin references that for Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification. It does not state a universal precertification requirement or process for all covered items in this policy. Documentation: For diabetes self-care programs: the program must be ordered by the physician treating the member's diabetes and must include a statement signed by the physician that the service is needed.; For specialty pharmacy items, a Statement of Medical Necessity (SMN) precertification form may be required (see Specialty Pharmacy Precertification). Policy exclusions and limitations: Anti-GAD antibody measurement is considered experimental, investigational, or unproven for predicting the onset of diabetes and for all other indications (other than distinguishing type 1 from type 2 diabetes when clinical history is ambiguous, or diagnosing stiff-person syndrome).; Use of jet injectors for reasons other than the member/caregiver being physically unable to use a conventional needle-syringe is considered a matter of preference and convenience (not covered).; Long-term therapeutic use of a CGM device is considered experimental, investigational, or unproven for all other indications, including (not all-inclusive): gestational diabetes; member with type 2 diabetes not using intensive insulin regimens; monitoring blood glucose in non-diabetic members following gastric bypass surgery; neonatal hypoglycemia; and nesidioblastosis (primary islet cell hypertrophy).; Alternate site blood glucose monitors have no proven value over standard blood glucose monitors for indications other than the two covered indications (not covered for other indications).; The I-Port Injection Port (Patton Medical) is considered a non-covered convenience item.; Combination devices that include a home blood glucose monitor combined with a blood pressure monitor, cholesterol screening analyzer, or other devices (e.g., cellular telephone) not specifically indicated for the management of diabetes mellitus are considered not medically necessary convenience items.; Hypoglycemic wristband alarms (e.g., Sleep Sentry) are a noncovered convenience item.; A feature allowing wireless transmission of blood glucose test results (cellular-enabled glucometer) is considered an integral part of the glucometer and is not separately reimbursed.; Computer software for analyzing blood glucose monitor test results is considered an integral part of a blood glucose monitor and is not separately reimbursed.; Lasette Laser Blood Glucose Monitoring Device is experimental/investigational/unproven — insufficient evidence that laser skin perforation offers clinically significant advantages over standard lancets.; Glycated serum proteins (fructosamine) measurement (e.g., Duet Glucose Control System by LXN Corporation) is experimental/investigational/unproven — clinical utility has not been established.; PreDx Test is experimental/investigational/unproven — inadequate evidence in the published peer-reviewed clinical literature regarding its effectiveness.; GlucoWatch Biographer Monitor is experimental/investigational/unproven.; Home glycated hemoglobin (HbA1c/A1C) monitors (e.g., A1cNow Diabetes Monitor) are experimental/investigational/unproven — no prospective clinical studies demonstrating improvements in compliance or other clinically significant benefits over laboratory A1C testing (individual-case exceptions may be made on medical review for members unable to access laboratory A1C testing).; Mobile application software for self-management of diabetes (e.g., BlueStar, d-Nav) is considered experimental, investigational, or unproven because its effectiveness has not been established.; Personal digital assistant-based blood glucose monitors are experimental/investigational/unproven — not shown in published clinical studies to improve clinical outcomes over standard blood glucose monitors.; Infrared thermometer device for intermittent measurement/monitoring of skin surface temperature (e.g., TempTouch) is experimental/investigational/unproven for reducing the risk of diabetic foot ulceration — insufficient evidence.; Measurement of advanced glycation end products by skin autofluorescence is experimental/investigational/unproven — insufficient evidence of effectiveness compared to the oral glucose tolerance test.; Remote/remote wireless glucose monitoring devices (e.g., mySentry) are experimental/investigational/unproven — insufficient published evidence of impact on clinical outcomes.; An attachment to allow wireless transmission from a continuous glucose monitor to a smart phone or computer (e.g., MiniMed Connect) is not covered because it is considered a convenience feature.; No additional reimbursement is provided for a wireless transmission feature integrated into a continuous glucose monitor (e.g., Dexcom SHARE) because it is considered a convenience feature.; Cellular activation therapy (e.g., Bionica Microdose infusion pump) is experimental/investigational/unproven.; Skin microvascular flow-motion is experimental/investigational/unproven.; Kihealth Diabetes Risk Test is experimental/investigational/unproven. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Diabetes Tests, Programs and Supplies?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. The bulletin references that for Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification. It does not state a universal precertification requirement or process for all covered items in this policy. Documentation: For diabetes self-care programs: the program must be ordered by the physician treating the member's diabetes and must include a statement signed by the physician that the service is needed.; For specialty pharmacy items, a Statement of Medical Necessity (SMN) precertification form may be required (see Specialty Pharmacy Precertification).
What does Aetna exclude for Diabetes Tests, Programs and Supplies?
Policy exclusions and limitations: Anti-GAD antibody measurement is considered experimental, investigational, or unproven for predicting the onset of diabetes and for all other indications (other than distinguishing type 1 from type 2 diabetes when clinical history is ambiguous, or diagnosing stiff-person syndrome).; Use of jet injectors for reasons other than the member/caregiver being physically unable to use a conventional needle-syringe is considered a matter of preference and convenience (not covered).; Long-term therapeutic use of a CGM device is considered experimental, investigational, or unproven for all other indications, including (not all-inclusive): gestational diabetes; member with type 2 diabetes not using intensive insulin regimens; monitoring blood glucose in non-diabetic members following gastric bypass surgery; neonatal hypoglycemia; and nesidioblastosis (primary islet cell hypertrophy).; Alternate site blood glucose monitors have no proven value over standard blood glucose monitors for indications other than the two covered indications (not covered for other indications).; The I-Port Injection Port (Patton Medical) is considered a non-covered convenience item.; Combination devices that include a home blood glucose monitor combined with a blood pressure monitor, cholesterol screening analyzer, or other devices (e.g., cellular telephone) not specifically indicated for the management of diabetes mellitus are considered not medically necessary convenience items.; Hypoglycemic wristband alarms (e.g., Sleep Sentry) are a noncovered convenience item.; A feature allowing wireless transmission of blood glucose test results (cellular-enabled glucometer) is considered an integral part of the glucometer and is not separately reimbursed.; Computer software for analyzing blood glucose monitor test results is considered an integral part of a blood glucose monitor and is not separately reimbursed.; Lasette Laser Blood Glucose Monitoring Device is experimental/investigational/unproven — insufficient evidence that laser skin perforation offers clinically significant advantages over standard lancets.; Glycated serum proteins (fructosamine) measurement (e.g., Duet Glucose Control System by LXN Corporation) is experimental/investigational/unproven — clinical utility has not been established.; PreDx Test is experimental/investigational/unproven — inadequate evidence in the published peer-reviewed clinical literature regarding its effectiveness.; GlucoWatch Biographer Monitor is experimental/investigational/unproven.; Home glycated hemoglobin (HbA1c/A1C) monitors (e.g., A1cNow Diabetes Monitor) are experimental/investigational/unproven — no prospective clinical studies demonstrating improvements in compliance or other clinically significant benefits over laboratory A1C testing (individual-case exceptions may be made on medical review for members unable to access laboratory A1C testing).; Mobile application software for self-management of diabetes (e.g., BlueStar, d-Nav) is considered experimental, investigational, or unproven because its effectiveness has not been established.; Personal digital assistant-based blood glucose monitors are experimental/investigational/unproven — not shown in published clinical studies to improve clinical outcomes over standard blood glucose monitors.; Infrared thermometer device for intermittent measurement/monitoring of skin surface temperature (e.g., TempTouch) is experimental/investigational/unproven for reducing the risk of diabetic foot ulceration — insufficient evidence.; Measurement of advanced glycation end products by skin autofluorescence is experimental/investigational/unproven — insufficient evidence of effectiveness compared to the oral glucose tolerance test.; Remote/remote wireless glucose monitoring devices (e.g., mySentry) are experimental/investigational/unproven — insufficient published evidence of impact on clinical outcomes.; An attachment to allow wireless transmission from a continuous glucose monitor to a smart phone or computer (e.g., MiniMed Connect) is not covered because it is considered a convenience feature.; No additional reimbursement is provided for a wireless transmission feature integrated into a continuous glucose monitor (e.g., Dexcom SHARE) because it is considered a convenience feature.; Cellular activation therapy (e.g., Bionica Microdose infusion pump) is experimental/investigational/unproven.; Skin microvascular flow-motion is experimental/investigational/unproven.; Kihealth Diabetes Risk Test is experimental/investigational/unproven. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0070 — Diabetes Tests, Programs and Supplies

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0070 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.