Florida Medicaid: Changes to reimbursement rules for diabetic supplies

As of Oct. 1, 2024, Florida Medicaid began reimbursing the following continuous glucose monitors and diabetic supplies as a pharmacy benefit:

Approvable ICD-10 codes
ICD-10 code	Description
Disease group: E10	Type 1 diabetes mellitus
Disease group: E11	Type 2 diabetes mellitus
Disease group: O24	Diabetes mellitus in pregnancy, childbirth and the puerperium
Disease group: E16.1	Other hypoglycemia
Disease group: E16.2	Hypoglycemia, unspecified
Disease group: E74.0	Glycogen storage disease

Automatic prior authorization will apply to continuous glucose monitors, transmitters and sensors. These procedure codes will no longer be located on the Florida Medicaid durable medical equipment (DME) fee schedule.

This applies to claims with a diagnosis of diabetes type 1, diabetes type 2, gestational diabetes, glycogen storage disease or hypoglycemia within the previous 730 days AND a fill with an insulin product within the previous 90 days.

New code removals starting Jan. 1

On Jan. 1, 2025, we’ll remove several codes associated with glucose monitors and diabetic supplies from the Medicaid DME fee schedule and will reimburse these supplies as a pharmacy benefit only.

We updated our policy in accordance with Florida Medicaid’s recent change to their glucose monitors and diabetic supplies reimbursement rules.

Beginning Jan. 1, we’ll reimburse the following supplies as a pharmacy benefit:

Diabetes glucose meters
Diabetic test strips
Continuous glucose monitors
Transmitters and sensors

External insulin pumps
Control solution
Ketone test strips
Lancets and devices

Pen needles
Re-usable insulin pens
Syringes

Diabetic test strips and lancets will continue to be subject to the current quantity limits.

If you submit claims for these supplies under DME after Jan. 1, 2025, we’ll deny the claim. If you submit claims for these supplies prior to Jan. 1, 2025, we’ll process the claim through DME, and members will be able to receive their diabetic supplies through both DME and the pharmacy.

In addition, you’ll need to fill out the Non-Preferred Diabetic Supply (DSP) Florida Medicaid Authorization Form for non-preferred devices and supplies on Jan. 1.