MedicaidCoverageMedium impact
22-467m CalViva Health Medi-Cal Members Get More Coverage for Medical Supplies under Medi-Cal Rx
Health Net·CA · Endocrinology, Family Medicine, Internal Medicine +2 more·Prior Authorization
Effective date
Jun 1, 2022
We identified it
Jun 20, 2026
Summary
CalViva Health expanded Medi-Cal Rx coverage for medical supplies in Fresno, Kings, and Madera counties, including relaxed restrictions on continuous glucose monitors (CGM) allowing up to 3 sensors per 30 days and new coverage for home blood pressure monitors starting June 1, 2022. Both CGMs and blood pressure monitors require prior authorization and must be from approved covered device lists.
Action Required
Billing team must verify CGM and home blood pressure monitor coverage using the approved device lists on the Medi-Cal Rx website before billing. Ensure prior authorization is obtained for therapeutic CGMs with updated quantity limits (3 sensors per 30 days, 9 per 90 days). Update billing procedures to route blood pressure monitors through pharmacy billing rather than medical billing for CalViva Health Medi-Cal members in Fresno, Kings, and Madera counties.