MedicaidCoverageHigh impact
REVISED: Continuous Glucose Monitor (CGM) Systems and Supplies – Effective 9/1/2026
Arkansas Medicaid·AR · Endocrinology, Pediatrics, Internal Medicine +2 more·Laboratory & Genetics
Effective date
Sep 1, 2026
We identified it
Sep 29, 2026
Summary
Effective September 1, 2026, Arkansas Medicaid (DHS) now covers Continuous Glucose Monitor (CGM) systems and supplies for both adjunctive and non-adjunctive use. DME providers (PT 16) must obtain prior authorization through Prime Therapeutics via fax or submit claims through the pharmacy portal; reimbursement follows Medicare fee schedule for HCPCS submissions or WAC plus dispensing fee for pharmacy submissions.
Action Required
By September 1, 2026: (1) Billing team must establish prior authorization submission process for CGM claims—download DME PA Request form and fax to Prime Therapeutics at 1-800-424-7976 for all A and E HCPCS CGM codes (A4238, A4239, E2102, E2103). (2) Update billing system to recognize approved CGM prior authorizations in MMIS-Gainwell Arkansas Provider Portal and configure claims for Medicare fee schedule reimbursement. (3) Alternatively, configure system to submit CGM and supply claims through Prime portal (established 8/1/2024) as pharmacy claim type for WAC plus professional dispensing fee reimbursement. (4) For members not using CGMs, continue submitting other diabetic testing supplies (blood glucose meters/strips) through existing pharmacy claim process established 8/1/2024. (5) Update front-desk and provider workflows to flag CGM requests and ensure prior authorization is obtained before supply delivery. Failure to obtain prior authorization will result in claim denials.