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TO:    All Providers

RE:    REVISED - Continuous Glucose Monitor Policy Updates

Effective October 1, 2025, Continuous Glucose Monitors (CGMs) will be covered through the Durable Medical Equipment (DME) Program with prior authorization (PA) for recipients (children and adults) with one of the following:

•        type 1 diabetes mellitus
•       type 2 diabetes mellitus AND are insulin treated with multiple (three or more) daily injections of insulin

NOTE: CGMs are not covered through the pharmacy benefit; requests must be submitted by a DME-enrolled provider with an active National Provider Identifier (NPI). Please review the full coverage criteria located on the durable medical equipment (DME) webpage at https://medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME/4.3.17_CGM.aspx.

An updated checklist is available on the DME webpage. https://medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME/4.3.16_DME_PA_Checklists.aspx.

The Provider Billing Manual will be updated with the new criteria as soon as possible. Policy questions concerning this ALERT should be directed to the DME Program at (334) 242-5050.