CurrentNorth Dakota Department of Health & Human ServicesPolicy N/A

Continuous Glucose Monitor and Supplies

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This policy governs North Dakota Medicaid coverage routing and prior authorization for continuous glucose monitors and related supplies. It applies to providers submitting claims under the Medicaid fee-for-service program, with pharmacy-claim billing generally used except for Medicare crossover claims.

Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicyContinuous Glucose Monitor and Supplies

Policy CodePolicy N/A

Change TypeAdministrative maintenanceno coverage changes

Effective DateJuly 1, 2021

Last ReviewSep 11, 2025

Next Review DateN/A

Key ActionSubmit the applicable continuous glucose monitor prior authorization form to Acentra.

SourceLink

POLICY UPDATE CHANGES

Administrative links to the pharmacy policy, prior authorization form, and related coverage information were added or revised during policy maintenance.

RequiredPrior authorization for continuous glucose monitors

Pharmacy claimsStandard ND Medicaid billing channel for CGMs and supplies

DME claimsMedicare crossover billing channel

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CurrentNorth Dakota Department of Health & Human ServicesPolicy N/A

Continuous Glucose Monitor and Supplies

Customize your policy alerts

Sign up for all North Dakota Department of Health & Human Services policy alerts

Know when North Dakota Department of Health & Human Services releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicyContinuous Glucose Monitor and Supplies

Policy CodePolicy N/A

Change TypeAdministrative maintenanceno coverage changes

Effective DateJuly 1, 2021

Last ReviewSep 11, 2025

Next Review DateN/A

Key ActionSubmit the applicable continuous glucose monitor prior authorization form to Acentra.

SourceLink

POLICY UPDATE CHANGES

Administrative links to the pharmacy policy, prior authorization form, and related coverage information were added or revised during policy maintenance.

RequiredPrior authorization for continuous glucose monitors

Pharmacy claimsStandard ND Medicaid billing channel for CGMs and supplies

DME claimsMedicare crossover billing channel

Prior Authorization Requirements

Prior Authorization

Obtain CGM prior authorization

Prior authorization is required for a continuous glucose monitor through Acentra.

Documentation Required

Submit the CGM authorization form

Submit the applicable continuous glucose monitor prior authorization form to Acentra.

Required Documentation

Documentation Required

Follow the Acentra authorization process

Use the applicable prior authorization process and form through Acentra when requesting coverage for a continuous glucose monitor.

Continuous Glucose Monitor Overview

A continuous glucose monitor (CGM) is a device used to track glucose levels continuously or at frequent intervals. This policy addresses administrative authorization and claim-routing requirements for CGMs and related supplies under North Dakota Medicaid fee-for-service. Prior authorization is required through Acentra. Except for Medicare crossover claims, CGMs and supplies are generally billed through pharmacy claims; Medicare crossover claims are billed through DME when Medicare pays first.

Policy Summary

PayerNorth Dakota Department of Health & Human Services

PolicyContinuous Glucose Monitor and Supplies

Policy CodePolicy N/A

Change TypeAdministrative maintenanceno coverage changes

Effective DateJuly 1, 2021

Last ReviewSep 11, 2025

Next Review DateN/A

Key ActionSubmit the applicable continuous glucose monitor prior authorization form to Acentra.

SourceLink

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