016.06.48-242.113. Continuous Glucose Monitors
AR ADC 016.06.48-242.113Arkansas Administrative CodeEffective: January 21, 2022
Effective: January 21, 2022
Ark. Admin. Code 016.06.48-242.113
016.06.48-242.113. Continuous Glucose Monitors
A. A Continuous Glucose Monitor (CGM) is covered by Arkansas Medicaid as set out in Section 212.208 of this provider manual.
B. The correct procedure codes and modifiers are found in the following link:
View or print the procedure codes and modifiers for Durable Medical Equipment (DME), oxygen equipment and supplies, orthotic appliances, prosthetic devices and medical supplies, procedures and services. [FN1]
C. A prior authorization (PA) is required for a CGM. Requests for prior authorization must be submitted to DHS or its designated vendor. View or print contact information for how to submit the request. [FN1] Requests must be made on form DMS-679A titled Prescription & Prior Authorization Request for Medical Equipment Excluding Wheelchairs & Wheelchair Components. (View or print form DMS-679A and instructions for completion. [FN1])
Credits
Adopted Jan. 21, 2022.
Nonfunctioning link so in original.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.48-242.113, AR ADC 016.06.48-242.113
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