Currentblue cross blue shield - michiganPolicy N/A

Continuous Blood Glucose Monitors (Therapeutic CGMs)

Defines Medicare Plus Blue (Medicare Advantage PPO) enhanced benefit coverage, reimbursement, payment conditions, and member cost sharing for continuous blood glucose monitors and related supplies for Medicare Advantage members.

Policy Summary

Payerblue cross blue shield - michigan

PolicyContinuous Blood Glucose Monitors (Therapeutic CGMs)

Policy CodePolicy N/A

Change TypeTemplate transition — no material coverage changes

Effective Date01/01/2026

Next Review DateN/A

Key ActionSubmit claims using HCPCS A9276, A9277, A9278 and reference the Medicare Plus Blue PPO Enhanced Benefit Fee Schedule on Availity for maximum payment amounts.

SourceLink

POLICY UPDATE CHANGES

Transitioned to new template; approval date reflects date approved by Medicare Advantage Medical Director and/or delegated clinician. No changes made to benefit and payment conditions.

A9276,A9277,A9278HCPCS referenced

100%Member cost sharing

NoneProvider/location limits

2026-01-01Effective date

Therapeutic CGM Coverage Conditions

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Therapeutic CGM coverage conditions

Coverage and payment conditions for therapeutic continuous glucose monitors for Medicare Advantage members:

ALL of the following

Services covered up to 100% of the approved amount.
Coverage applies to HCPCS codes A9276, A9277, A9278.
No restrictions on eligible provider or payable location.
No frequency limits specified in this policy; follow fee schedule and allowed amounts on provider portal.
Provider will be paid the lesser of the allowed amount on the Medicare Plus Blue fee schedule or the provider's charge, minus member cost share; providers may not balance-bill members for the difference.
No diagnosis or age restrictions specified.

Devices included: sensors, transmitters, and receivers as described by HCPCS A9276–A9278.

HCPCS Codes and Frequency/Quantity

CGM HCPCS codesHCPCSCovered

A9276	Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply.
A9277	Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM).
A9278	Receiver (monitor); external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM).

Frequency / Quantity Limits & Payment Notes

Frequency/Quantity LimitsNo restrictions specified in this policy; follow the Medicare Plus Blue PPO Enhanced Benefit Fee Schedule on the provider portal (Availity) for allowed amounts and maximum payment.

Eligible providerNo restrictions — any eligible provider may bill for covered CGM items.

Payable locationNo restrictions on payable location.

Reimbursement methodProvider paid the lesser of the allowed amount on the Medicare Plus Blue fee schedule or the provider's charge, minus member cost share; providers may not balance-bill members.

Payment and Provider Requirements

Billing Rule

Payment and provider requirements for therapeutic CGMs

No provider or location restrictions; payment is limited to HCPCS codes A9276, A9277, A9278. Providers must reference the Medicare Plus Blue PPO Enhanced Benefit Fee Schedule on Availity for maximum payment amounts and submit claims per BCBSM reimbursement policies. Payment will be the lesser of the allowed amount on the fee schedule or the provider's charge, minus the member's cost share; providers may not balance-bill members for the difference.

Eligible provider: No restrictions.
Payable location: No restrictions.
CPT/HCPCS code restriction: A9276, A9277, A9278.
Frequency limits: No restrictions specified; follow fee schedule and allowed amounts on Availity.
Reimbursement method: Paid the lesser of allowed amount or provider charge, minus member cost share; providers may not bill member for the difference.
Where to find fee schedule: Availity Essentials → Secure Provider Resources → Fee Schedules → Medicare Plus Blue PPO Enhanced Benefit Fee Schedule.

Device Definitions

Continuous Glucose Monitor Devices and Codes

Sensor (A9276)Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = 1 day supply.

Transmitter (A9277)Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM).

Receiver/Monitor (A9278)Receiver (monitor); external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM).

DefinitionContinuous glucose monitors are devices used to track blood glucose levels throughout the day and night; includes sensors, transmitters, and receivers as described by HCPCS A9276–A9278.