MedicaidPrior AuthHigh impact
Fee-for-service coverage of CGM devices effective January 1, 2024
Oregon Health Plan·OR · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Starting January 1, 2024, Oregon Medicaid will cover CGM devices for Type 2 and gestational diabetes patients, but providers must order through local pharmacies instead of DME suppliers for fee-for-service patients. Prior authorization will be required through the Oregon Pharmacy Call Center.
Action Required
By January 1, 2024: For Oregon Medicaid fee-for-service patients needing CGM devices, providers must order through local pharmacies instead of DME suppliers. Billing team must prepare for new prior authorization requirements through Oregon Pharmacy Call Center (criteria to be published in January 2024). Continue using DME suppliers only for Medicare crossover claims and follow CCO-specific procedures for coordinated care members.