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TO: All Providers
RE: REVISED - Continuous Glucose Monitor Policy Updates
Effective October 1, 2025, Continuous
Glucose Monitors (CGMs) will be covered through the Durable Medical Equipment
(DME) Program with prior authorization (PA) for recipients (children and
adults) with one of the following:
· type 1 diabetes mellitus
· type 2 diabetes mellitus or gestational
diabetes AND are insulin treated with multiple (three or more) daily injections
of insulin
NOTE: CGMs are not covered
through the pharmacy benefit; requests must be submitted by a DME-enrolled
provider with an active National Provider Identifier (NPI). Please
review the full coverage criteria located on the durable medical equipment
(DME) webpage at https://medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME/4.3.17_CGM.aspx.
An updated checklist is
available on the DME webpage. https://medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME/4.3.16_DME_PA_Checklists.aspx.
The Provider Billing
Manual will be updated with the new criteria as soon as possible. Policy
questions concerning this ALERT 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 © 2025 American Medical Association
and © 2025 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.