Alerts

Durable Medical Equipment (DME) Program Updates Related to Continuous Glucose Monitor (CGM) Update

10/10/2023

PDF Version


TO:  DME Providers, Prosthetics & Orthotics (P&O) Providers, Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, and Nursing Homes

 

RE:   Durable Medical Equipment (DME) Program Updates Related to Continuous Glucose Monitor (CGM) Update

 

Effective November 1, 2023, the Alabama Medicaid Agency’s Durable Medical Equipment Program will make changes to:

 

·         CGM Billing Procedures

·         CGM Prior Authorization requests

·         CGM Reimbursement for codes A4239 and E2103

 

Detailed information about the changes is below. 

 

  1. For NEW prior authorization requests submitted on or after November 1, 2023, providers must bill and submit on the prior authorization CGM procedure codes A4239 and E2103 for non-adjunctive CGM models.    

 

  1. Procedure code A4239 is for all supplies and accessories for one month supply per the CGM model requirements and is equal to one unit of service. Supplies will be approved no longer than one year OR the expiration of the written order/prescription (whichever comes first).

 

  1. Procedure code E2103 will be used for the non-adjunctive, non-implanted continuous glucose monitor or receiver. Supplies will be approved no longer than one year OR the expiration of the written order/prescription (whichever comes first). (CGM receivers are limited to one every five years, require prior authorization and will be considered based upon the review of submitted documentation.)

 

  1. Existing prior authorizations approved for A9276, A9277, and A9278 prior to November 1, 2023, will remain active and providers will be allowed to bill remaining units on existing prior authorizations through October 31, 2024.

 

  1. Procedure codes A9276, A9277, and A9278 will be non-covered on November 1, 2024.

 

  1. Reimbursement for codes A4239 and E2103 will be established via manual pricing based on the provider’s invoice cost + 20 percent. Invoices must be submitted with the prior authorization request.

 

Policy questions concerning this provider notice should be directed to the DME Program at (334) 242-5050.           


The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2023 American Medical Association and © 2023 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.