MedicaidReimbursementMedium impact
2025.39 - Provider Bulletin - Revised Billing Guidelines for CGMs & Adjunctive Non-Implanted CGMs
Connecticut Medicaid (HUSKY Health)·CT · Endocrinology, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY Health) is adding 100% of Medicare fee schedule as a third pricing tier for continuous glucose monitor (CGM) billing, creating a new reimbursement methodology with three options: MSRP minus 15%, actual acquisition cost plus 25%, or 100% of Medicare rates. This affects both non-adjunctive and adjunctive CGM systems.
Action Required
By September 1, 2025: Billing team must update DME billing systems to include new three-tier pricing methodology for CGM codes A4239, E2103, A4238, and E2102. Verify system calculates reimbursement as lesser of MSRP minus 15%, AAC plus 25%, or 100% Medicare fee schedule. Download updated fee schedule from www.ctdssmap.com. Ensure A4233-A4259, E0607, and E2101 are not billed separately when A4239 is used within 30 days for same patient.