All GM employees receive continuous glucose monitor benefit

Effective Jan. 1, 2016, continuous glucose monitors became a benefit for all General Motors’ hourly employees. The following information applies to all GM members, including GM salaried members who already have this benefit.

The following guidelines must be met for the continuous glucose monitor to be considered for reimbursement for these members:

• Patients with recurrent unexplained severe hypoglycemia
• Pregnant women with insulin-requiring diabetes complicated by recurrent hypoglycemia, which has not been resolved by following best practices
• Patients who have recurrent unexplained severe hypoglycemia and who do not already have an adequately functioning insulin pump may be considered for glucose sensors and transmitters associated with an integrated insulin pump.
• The patient must complete a comprehensive diabetes education program. Care management participation is required for continuous glucose monitor claims to be paid.

The relevant procedure codes are A9276, A9277 and A9278.

When claims are submitted for these procedure codes, the following supporting documentation must be on file or claims will be rejected:

• Prescription for equipment and supplies with a duration of need specified on the prescription
• Blood sugar logs with two to three months of information
• Treatment notes, including evidence of recurrent hypoglycemic unawareness
• History of the medical condition and documents to support medical necessity, including lab results

GM follows the standard Blue Cross Blue Shield of Michigan processing processing guidelines for this benefit.

Note: Patients must meet the criteria for both the continuous subcutaneous insulin infusion pump as well as for the continuous glucose monitor.