Aetna HAS changed their clinical policy bulletin! It now states:
Continuous Glucose Monitoring Devices:
Aetna considers continuous glucose monitoring devices (e.g., MiniMed Continuous Glucose Monitoring System, Guardian Real-Time Continuous Glucose Monitoring System, and the DexCom STS), which are used to continuously monitor diabetic persons’ blood glucose levels over a three-day (72-hour) period, medically necessary for persons with type 1 diabetes who have either of the following problems in controlling blood glucose level, unresponsive to conventional insulin dose adjustment:
repeated hypo- and hyperglycemia at the same time each day; or
No more than two CGMS monitoring periods are considered medically necessary within a 12-month period.
Aetna considers the long-term use of continuous glucose monitoring devices medically necessary as an adjunct to fingerstick testing of blood glucose in persons with type 1 diabetes who have had recurrent episodes of severe hypoglycemia (blood glucose less than 50mg/dL) despite appropriate modifications in insulin regimen and compliance with frequent self-monitoring (at least four fingersticks per day). Long-term use of continuous glucose monitoring devices are considered experimental and investigational for all other indications. Note: For long-term use for recurrent hypoglycemia, the CGMS monitor must be used by the member on a trial basis for a minimum of one month (30 days), but not to exceed two months. The trial period will be paid as a rental. The trial period must be monitored by the physician to determine the effectiveness of the CGMS monitor. For coverage of a purchase, the physician must determine that the member is likely to derive significant therapeutic benefit from continuous use of CGMS over a long period of time. The physician’s records must document a reevaluation of the member at the end of the trial period, must indicate compliance with the use of the CGMS monitor, and the results of the use.