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Diabetic Supply Billing Notice
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 2, 2026
Summary
Mississippi Division of Medicaid will move fifteen diabetes supply HCPCS codes from the medical/DME benefit to exclusive pharmacy billing effective January 1, 2027, so these supplies will need NDC-based pharmacy claims. A transition period runs from October 1 through December 31, 2026, and the change is aimed at letting Medicaid collect manufacturer rebates. Eight other diabetes supply codes remain eligible for medical/DME billing.
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What to do
by Jan 1, 2027 · 7 steps
01Stop billing the fifteen listed HCPCS codes to Mississippi Medicaid through the medical/DME benefit, and bill those supplies through the pharmacy benefit with NDC information instead.
02Billing team: Before then, find the patients on Mississippi Medicaid who receive these codes, and in charge entry and claim systems flag the codes for pharmacy routing.
03Check the Mississippi Medicaid Preferred Diabetic Supply List and the Pharmacy Drug Coverage Inquiry tool to confirm which NDCs are preferred and whether any have obsolete dates.
04For non-preferred products, prior authorization can be requested from the Gainwell Pharmacy Prior Authorization Unit through the Gainwell provider web portal.
05DME providers: Help patients get supplies from their pharmacy, and adjust inventory before the change.
06Prescribers: Review the preferred list and prescribe preferred products when clinically appropriate, and work with patients who use non-preferred products to switch before January 1, 2027.
07Front desk staff: Tell patients that Medicaid members with a preferred product can ask their provider for a pharmacy prescription now, since the notice says they can fill it at a local pharmacy now.
Codes mentioned
A4215A4239A4250A4253A4256A4258A4259A9274A9276A9277A9278E0607E2100E2103S8490
Original notice
Diabetic Supply Billing Notice
medicaid.ms.gov · Always check the source before changing claims.