Provider Notices

Continuous Glucose Monitors (CGM) - Coverage Update

12/18/2018 2:11:17 PM

Beginning January 18th, 2019 Non-therapeutic CGM’s will not be covered under PacificSource Community Solutions.

A Non-therapeutic CGM device is used as an adjunct to home blood glucose monitor testing. It is not a replacement for home blood glucose monitors. It does not perform a medically necessary function and is not used to make diabetes treatment decisions.  It is precautionary. Any CGM system that does not have the FDA designation as a “replacement for home blood glucose monitor” would be considered a “non-therapeutic” CGM.

The codes associated are A9276 sensor, A9277 transmitter and A9278 Receiver.


A Therapeutic CGM (K0553 and K0554) is covered and may be ordered through a contracted DME company or an in-network pharmacy.


Beginning January 18th, 2019 PacificSource Community Solutions will cover a Dexcom 6 or Freestyle Libre through the pharmacy benefit, with a prior authorization. The PA requirements are posted on the PSCS website under the drug field search.