Important Information for Prescribers
For CenCal CareConnect D-SNP members, therapeutic Continuous Glucose Monitors (CGMs):
- Are covered under Medicare Part B
- Should be dispensed through in-network retail pharmacies
- Are processed under Medicare Part at the pharmacy point of sale
- Do NOT require prior authorization through CenCal DME
Submitting a DME authorization request for CGMs may delay your patient’s access to therapy.
What Providers Should Do
- Send the CGM prescriptions to an in-network retail pharmacy.
- Do NOT submit a DME prior authorization request to CenCal Health.
- Ensure clinical documentation supports medical necessity under Medicare Part B (CMS NCD 280.1).
Retail pharmacies will process CGM claims under Medicare Part B at the point of sale.
CGM Products Included
Examples include:
- Dexcom (G6, G7)
- FreeStyle Libre (Libre 2, Libre 3)
Related supplies, including:
- CGM sensors, CGM transmitters, CGM receivers
Coverage Requirements
Coverage must meet Medicare Part B medical necessity requirements under: CMS National Coverage Determination (NCD) 280.1- Glucose Monitors.
Quick Reference
| Question | Answer |
| Do CGMs require prior authorization? | No |
| Where should prescriptions be sent? | An in-network retail pharmacy. |
| Should patients be referred to DME suppliers? | No. CGMs should be dispensed through retail pharmacies. |
Questions? For assistance, please contact 1-805-562-1080 or [email protected]