BlueCross BlueShield of Tennessee Medical Policy Manual

Diabetes Management

DESCRIPTION

Diabetes is a chronic illness that requires continuing medical care and education in order to prevent acute complications and reduce the risk of developing other conditions related to uncontrolled blood glucose. These other conditions may include retinopathy, nephropathy, neuropathy and cardiovascular disease.

POLICY

MEDICAL APPROPRIATENESS

APPLICABLE TENNESSEE STATE MANDATE REQUIREMENTS

Tennessee Code Annotated, Title 56, Chapter 7, Part 2605

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Providers that will be recognized to provide the outpatient self-management diabetic training, educational services, and the nutritional counseling include:

SOURCES

American Association of Clinical Endocrinologists. (2015). American Association of Clinical Endocrinologists and American College of Endocrinology – Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan. Retrieved February 17, 2017 https://www.aace.com.

American Diabetes Association. (2017). Standards of medical care in diabetes - 2017. Retrieved February 17, 2017 from: www.Diabetes.org/diabetescare. 

American Optometric Association. (2014). Evidence-based clinical practice guideline: eye care of the patient with diabetes mellitus. Retrieved March 31, 2016 from the National Guideline Clearinghouse (NGC: 47915).

Centers for Medicare & Medicaid Services. CMS.gov. (201, July) National Coverage Determination (NCD) for diabetes outpatient self-management training (40.1). Retrieved February 17, 2017 from https://www.cms.gov.

Code of Federal Regulations. (2009, December) Title 42 - 410.140 - 410.146 Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements. Retrieved February 17, 2017 from: www.ecfr.gov.

Edelman, D., Fredrickson, S., Melnyk, S., Coffman, C., Jeffreys. A., Datta, S., et al. (2010). Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial. Annals of Internal Medicine, 152 (11), 689 - 696. (Level 1 evidence)

Halter, J., Musi, N., Horne, F. M., Crandall, J., Goldberg, A., Harkless, L., et al. (2014, August) Diabetes and Cardiovascular Disease in Older Adults: Current Status and Future Directions. Diabetes. 63 (8), 2578-2589. (Level 5 evidence)

Institute for Clinical Systems Improvement. (2014, July) Diagnosis and management of type 2 diabetes mellitus in adults. Retrieved March 30, 2016 from www.isci.org.

National Institute for Health and Care Excellence. (2014, December)  Type 2 diabetes in adults: management. Retrieved February 17, 2017 from: http://www.guidance.nice.org.uk. 

National Institute for Health and Care Excellence. (2016, July)  Diabetes in children, young people and adults. Retrieved February 17, 2017 from: http://www.guidance.nice.org.uk.  

Pfutzner, A., Weissmann, J., Mougiakakou, S., Daskalaki, E., Weis, N., & Ziegler, R. (2015). Glycemic variability is associated with frequency of blood glucose testing and bolus: post hoc analysis results from the ProAct study. Diabetes Technology & Therapeutics, 17 (6), 392-397. (Level 4 evidence)

Tennessee Code: Title 56 Insurance: Chapter 7 Policies and Policyholders: Part 26 Mandated Insurer or Plan Options: 56-7-2605. Equipment, supplies and outpatient services for diabetic patients. Retrieved February 17, 2017 from https://web.lexisnexis.com.  

U. S. Food and Drug Administration. (2008, January). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071788. Retrieved July 15, 2010 from http://www.accessdata.fda.gov.

ORIGINAL EFFECTIVE DATE:  7/1/1997

MOST RECENT REVIEW DATE:  3/23/2017

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.