Prior authorization for DexCom and FreeStyle Libre CGMs is being waived through the next calendar year (at a minimum Jan. 1 to Dec. 31, 2024) to support Ohio Department of Medicaid’s quality strategy and to increase access for appropriate use of continuous glucose monitors (CGMs). This is a result of the combined efforts of all Ohio Medicaid managed care plans and the Ohio Department of Medicaid.
Appropriate Certificate of Medical Necessity documentation should also be kept in the member’s individual medical record per Ohio Administrative Code 5160-10-36.
For claims, suppliers are required to be billed as follows with the appropriate HCPCS code, ICD-10 code, and modifiers as applicable.