Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 225 - Telemedicine
Chapter 4 - Continuous Glucose Monitoring Services
Rule 23-225-4.3 - Covered Services
Universal Citation: MS Code of Rules 23-225-4.3
Current through September 24, 2024
A. The Division of Medicaid covers:
1. A continuous glucose
monitoring (CGM) service when medically necessary, prior authorized by the
UM/QIO, Division of Medicaid or designee, ordered by the physician who is
actively managing the beneficiary's diabetes and the beneficiary meets all of
the following criteria:
a) Has an established
diagnosis of type I or type II diabetes mellitus that is poorly controlled as
defined below:
1) Unexplained hypoglycemic
episodes,
2) Nocturnal hypoglycemic
episode(s),
3) Hypoglycemic
unawareness and/or frequent hypoglycemic episodes leading to impairments in
activities of daily living,
4)
Suspected postprandial hyperglycemia,
5) Recurrent diabetic ketoacidosis,
or
6) Unable to achieve optimum
glycemic control as defined by the most current version of the American
Diabetes Association (ADA).
b) Be able, or have a caregiver who is able,
to hear and view CGM alerts and respond appropriately.
c) Has documented self-monitoring of blood
glucose at least four (4) times per day.
d) Requires insulin injections three (3) or
more times per day or requires the use of an insulin pump for maintenance of
blood glucose control.
e) Requires
frequent adjustment to insulin treatment regimen based on blood glucose testing
results,
f) Had an in-person visit
with the ordering physician within six (6) months prior to ordering to evaluate
their diabetes control and determined that criteria (1-4) above are
met,
g) Has an in-person visit
every six (6) months following the prescription of the CGM to assess adherence
to the CGM regimen and diabetes treatment plan.
2. CGM service only when the blood glucose
data is obtained from a Federal Drug Administration (FDA) approved durable
medical equipment (DME) medical device for home use.
B. The Division of Medicaid does not require the provider to have a face-to-face office visit with the beneficiary to download, review and interpret the blood glucose data.
42 U.S.C. § 1395 x(n); Miss. Code Ann. § 43-13-121.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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