05.00.05t, Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
Independence Blue Cross has reissued Policy 05.00.05t with minor clarifications to diabetes equipment, supplies, and pharmaceuticals coverage. The most recent update (10/29/2025) adds ICD-10 code E11.A (Type 2 diabetes mellitus without complications in remission) and HCPCS code J1612 (Injection, glucagon (gvoke), 0.01 mg), while previous updates added CGM and artificial pancreas device codes (K0553, K0554, S1034, S1035, S1036) and clarified coverage limits for blood glucose test strips (A4253) and lancets (A4259) at up to 200 units per month.