MedicaidBilling CodesHigh impact
Biomarker Testing Coverage Implemented Effective July 1, 2026
Mississippi Medicaid (DOM)·MS · Endocrinology, Family Medicine, Internal Medicine +2 more·Prior Authorization
Effective date
Jan 1, 2027
We identified it
Oct 3, 2026
Summary
Effective January 1, 2027, 15 specific diabetes supply HCPCS codes will transition from medical/DME billing to exclusive pharmacy billing on Mississippi Medicaid. A transition period runs October 1–December 31, 2026, during which the billing team must update systems to route these codes to pharmacy claims and ensure providers switch members to preferred products on the Diabetic Supply List (DSL). Eight HCPCS codes for insulin pump supplies and adjunctive CGM remain eligible for medical/DME billing and are unaffected.
Action Required
By October 1, 2026: (1) Billing team must update billing system to route HCPCS codes A4215, A4239, A4250, A4253, A4256, A4258, A4259, A9274, A9276, A9277, A9278, E0607, E2100, E2103, and S8490 to pharmacy benefit claims rather than medical/DME claims effective January 1, 2027. (2) Ensure all claims for these 15 codes include NDC (National Drug Code) information when billed through pharmacy. (3) Configure system to continue routing A4224, A4225, A4230, A4231, A4232, A4238, E0784, and E2102 through medical/DME benefit. (4) Providers and DME suppliers must educate members about the transition and assist them in obtaining prescriptions for preferred products from the Mississippi Medicaid Preferred Diabetic Supply List (DSL) available at https://medicaid.ms.gov/preferred-drug-list/. (5) Providers should document preferred product selections and transition non-preferred users to preferred alternatives before December 31, 2026. (6) Billing team should monitor the DSL for product obsolescence dates and alert providers when NDCs approach the 18-month post-obsolete billing cutoff. Failure to transition billing for these 15 codes to pharmacy by January 1, 2027, will result in claim denials. Note: Diabetes supplies do not count toward member monthly prescription limits.