Flash – CGM Changes – Changes for Continuous Glucose Monitors

Beginning on January 1, 2024, Health Alliance^TM will require durable medical equipment suppliers to bill for non-adjunctive Continuous Glucose Monitors (CGM) via pharmacy benefits through Optum for all Commercial plans.  In addition, our Medicare plans will allow for those members to receive their CGM’s either through a retail pharmacy or through a durable medical equipment supplier.  Those devices are typically billed with E2103 for the receiver and A4239 for the related supplies.

This change would impact the Freestyle Libre and Dexcom monitoring systems.  These items will also be available for our members at retail pharmacies.

This change does not impact the billing for insulin pumps or the CGM’s that are integrated with insulin pumps.

Please contact your Provider Relations Specialist with questions.