Prior Authorization Updates Related to Glucose Monitors

CarePartners of Connecticut would like to inform providers that we are updating our Prior Authorization and Inpatient Notification List, effective for dates of service beginning Nov. 1, 2022, to reflect changes the Centers for Medicare and Medicaid Services (CMS) has made to their Local Coverage Determination (LCD) for Glucose Monitors.

The updated language in the LCD provides further clarity regarding the use of terminology such as “continuous glucose monitors,” “therapeutic,” “non-adjunctive,” “non-therapeutic,” and “adjunctive.” In addition, as a result of the LCD update, prior authorization will be required for the following HCPCS codes:

• Adjunctive continuous glucose monitor or receiver
• A4238 – Supply allowance for adjunctive continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service

For more information, refer to the CarePartners of Connecticut Prior Authorization and Inpatient Notification List.