Does United Healthcare Cover CGM?

Does United Healthcare Cover CGM?

United Healthcare covers continuous glucose monitors (CGMs) to help patients suffering from diabetes remain healthy.

United Healthcare is happy to cover CGMs because their research shows that medically necessary for individuals managing type 1 diabetes or insulin-requiring type 2 diabetes.

United Healthcare covers CGMs in the following circumstances:

  • Short-term use (3-14 days) by a healthcare provider for diagnostic purposes.logo
  • Long-term use for personal use at home for managing individuals with diabetes during pregnancy when certain criteria are met. For medical necessity clinical coverage criteria, refer to the InterQual® Client Defined, CP: Durable Medical Equipment, Continuous Glucose Monitors (Custom) – UHG.
  • Long-term use for personal use at home for managing individuals with type 1 or type 2 diabetes when certain criteria are met. For medical necessity clinical coverage criteria, refer to the InterQual® Client Defined, CP: Durable Medical Equipment, Continuous Glucose Monitors (Custom) – UHG.

While United Healthcare does cover CGMs, they do not cover CGMs using a non-invasive device or those that use an implantable glucose sensor (ex: Eversense).

In order to qualify for a CGM through United Healthcare, patients need to provide certain documentation that varies by state. The patient needs a prescription, and the following:

Medical notes documenting the following, when applicable:

  • Provide the member’s current type of diabetes (i.e., Type I, Type II or Gestational)
  • Lab results from the last three (3) months
  • Provide the last 3 months of member’s office notes
  • Treatment plan
  • Current signed physician order
  • Provide the type of make and model of the device requested
  • If the request is to replace a device, provide the reason(s) why does the current device need replacement

If you have United Healthcare insurance, we can help you qualify for an insurance covered CGM.

 

Does United Healthcare Cover CGM?

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United Healthcare covers continuous glucose monitors (CGMs) to help patients suffering from diabetes remain healthy. Let us help get you covered.