BCBS of MA requiring prior approval for Dexcom

[jbowler]

It seems to be a routine MediCare requirement; CGM requires T1. IRC (I think this was discussed on another thread) the various immunological tests are also fine, CPT: 86337, for example:

504050: Diabetes Autoimmune Profile | Labcorp

The C-peptide should be CPT: 84681, based on the recent papers; a glucagon stimulation test, e.g.:

010108: C-Peptide | Labcorp

Notice that the CPT code is just some kind of “user friendly” code for a diagnostic test; so the actual tests performed may vary and may, so far as I can see, be completely useless.

The OP’s question is somewhat different; MediCare seem to accept past results, apparently BCBS are not prepared to accept anyone else’s BCBS, or even their own?

[MM2]

@ChrisAlb

Does anyone know if Medicare requires an ‘annual’ C-Peptide test?

I know Medicare requires C-peptide test for insulin pump approval, but only once. The original post was not clear if their insurance required it for cgm only.

My last pump was under insurance (not MC), but followed MC rules, so 2 years ago I had a C-peptide test. Glad it confirmed that I really was insulin dependent the last 50+ years. Will see if MC will require another test in a couple years.

[CatLady]

@MM2

Glad it confirmed that I really was insulin dependent the last 50+ years.