CommercialCoverageHigh impact
05.00.79m, Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems (IBC)
Independence Blue Cross·Endocrinology, Internal Medicine, Family Medicine +1 more·Medical Policy
Effective date
Sep 1, 2026
We identified it
Sep 2, 2026
Summary
Independence Blue Cross updated policy 05.00.79m effective 09/01/2026 to clarify coverage criteria for insulin pumps and continuous glucose monitoring (CGM) systems. Three HCPCS codes (A9276, A9277, A9278) for non-durable CGM supplies were added to the Not Eligible For Reimbursement section, meaning these sensor, transmitter, and receiver codes will no longer be covered. Billing teams must immediately identify and halt claims for these three codes to prevent denials.
Action Required
By 08/31/2026: Billing team must update billing system to deny or reject claims for HCPCS codes A9276 (CGM sensor), A9277 (transmitter), and A9278 (receiver) effective 09/01/2026. Create a billing rule in the system to flag these codes as Not Eligible For Reimbursement for IBC Commercial plans. Update internal coding guidelines and communicate to all billing staff that these three non-durable CGM supply codes are no longer reimbursable. Review any pending claims with these codes and resubmit without them or request patient responsibility. Providers should be notified via bulletin that members needing these CGM supplies may need to pursue coverage through pharmacy benefits instead, per policy guidance. Failure to implement these rejections will result in claim denials and additional rework.