LCD/NCD Portal

NCD40.3

 

CLOSED-LOOP BLOOD GLUCOSE CONTROL DEVICE (CBGCD)

 

Effective Date of this Version

7/1/1983

 

Benefit Category

• Inpatient Hospital Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• The closed-loop blood glucose control device (CBGCD) is a hospital bedside device designed for short-term management of patients with insulin dependent diabetes mellitus (Type I).

• It consists of

o A rapid on-line glucose analyzer.

o A computer with a controller for the calculation and control of the infusion of either insulin or dextrose.

o A multi-channel infusion system.

o A printer designed to record continuous glucose values and to provide cumulative totals of the substances infused.

• Its primary use is for the stabilization of Type I diabetics during periods of stress, such as trauma, labor and delivery, and surgery, when there are wide fluctuations in blood sugar levels.

• It serves to temporarily correct abnormal blood glucose levels (hyper- or hypo-glycemia) and this correction is made by infusion of either insulin or dextrose.

• Its use is generally limited to a 24- to 48-hour period because of potential complications:

o Sepsis.

o Thromboses.

o Nonportability.

• The CBGCD requires specialized training for use and interpretation of its diagnostic and therapeutic contribution and continuous observation by specially trained medical personnel.

 

Indications and Limitations of Coverage

• Use of the CBGCD is covered for short-term management of insulin dependent diabetics in crisis situations, in a hospital inpatient setting, and only under the direction of specially trained medical personnel.

 

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