CommercialCoverageHigh impact
Continuous Glucose Monitoring Systems/External Insulin Pump Therapy for Diabetes 1.01.30
Excellus BlueCross BlueShield·Endocrinology, Family Medicine, Internal Medicine +1 more·Diabetes (Endocrinology)
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their comprehensive policy for continuous glucose monitoring systems and external insulin pump therapy for diabetes, establishing detailed coverage criteria for initial requests, replacements, and artificial pancreas systems. The policy includes specific requirements for multiple daily injections, glucose testing frequency, and diabetes education completion.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for insulin pumps (E0784) and CGM devices (A9276-A9278, E2102-E2103, A4238-A4239) to verify patients meet specific criteria including 3+ daily insulin injections, 3+ months of frequent dose adjustments, 3+ daily glucose tests or CGM use, and completion of diabetes education. Update encounter forms to prompt providers for documentation of poorly controlled diabetes evidence (HbA1c >7%, hypoglycemia history, glucose fluctuations). Claims will require comprehensive documentation to meet coverage criteria.