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[IP] CGMS Denial Info--Susan's question

Susan asked---

"Do you have to have all of the things listed to qualify, or just some?
I have been T1 for more than 50 years. I test 6 to 10 x a day
I don't go down to 50 or below very often.
I do go above 150 more than I'd like to.
I don't know if that means poor control.
I use a pump.
Do you think I would be qualified for a CGMS?"

Since you don't meet the criteria the answer would be "no." Since it  
sounds like you are in good control I doubt doing a peer to peer  
would overturn the decision either. In this case the physician  
reviewer would probably consider CGMS a "convenience" item and those  
are never covered.

Again, just my opinion. I am not the authority!

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