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NCD 40.3 · version 1

NCD 40.3: Closed-Loop Blood Glucose Control Device (CBGCD)

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: Medicare Coverage Database release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (every Thursday) for the MCD; quarterly for lab NCD code lists.

Key facts for NCD 40.3

Benefit category
Inpatient Hospital Services
Effective date
07/01/1983
Transmittal
n/a
Versions published
1
Manual chapter
40
NCD Manual (Pub. 100-03)

TL;DR

NCD 40.3 sets Medicare's national policy for closed-loop blood glucose control device (cbgcd) under the benefit category "Inpatient Hospital Services", effective 07/01/1983. 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. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.

Item or service described

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 a rapid on-line glucose analyzer; a computer with a controller for the calculation and control of the infusion of either insulin or dextrose; a multi-channel infusion system; and 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; (e.g., sepsis, thromboses, and nonportability, etc.). 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.

Text reproduced from the CMS Medicare Coverage Database record for NCD 40.3 version 1. View the original on cms.gov.

How this NCD shows up on remittances

A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.

How QuickIntell applies NCD 40.3

QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.

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Frequently asked questions — NCD 40.3

What does NCD 40.3 cover?

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. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.

When did NCD 40.3 take effect?

The current version (1) is effective 07/01/1983. This is the only published version.

Does a Local Coverage Determination override NCD 40.3?

No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.