Physicians/Specialists
Facilities/Hospitals
Ancillary
Publication Date: 
2018-08-27

In December, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will open our durable medical equipment (DME) network for the distribution of insulin pumps and continuous glucose monitors (CGMs).

To qualify for in-network eligibility under most of our commercial members’ benefit plans, we currently require these devices to be obtained through Edgepark Medical Supplies (Edgepark). We want to give our members more choices, so beginning December 1, 2018, insulin pumps, CGMs, and their related supplies will be eligible for in-network benefits when obtained from all network-participating suppliers.

This chart helps you understand where to go for insulin pumps, CGMs, and all related supplies before and after December 1, 2018:

Date Supplier(s) Blue Cross NC Membership
Before December 1, 2018 Insulin pumps, CGMs, and all related supplies for these devices should be purchased and rented from Edgepark.
  • All Blue Cross NC commercial members, including:
    • Individual, under-65
    • Administrative services only (ASO)
    • State Health Plan
    • Federal Employee Program
Beginning December 1, 2018 Insulin pumps, CGMs, and all related supplies for these devices may be purchased and rented from any DME supplier participating in Blue Cross NC’s commercial-product networks.
  • All Blue Cross NC commercial members, including:
    • Individual, under-65
    • Administrative services only (ASO)
    • State Health Plan
    • Federal Employee Program
Before and after December 1, 2018 (No Change) Insulin pumps, CGMs, and all related supplies for these devices should continue to be obtained from suppliers participating in Blue Cross NC’s Blue Medicare networks.
  • Blue MedicareSM

Edgepark will continue to offer insulin pumps, CGMs, and supplies as an in-network DME supplier option for Blue Cross NC’s commercial and Medicare Advantage members before, on, and after December 1, 2018.

Only insulin pumps, CGMs, and related supplies ordered and obtained from DME suppliers contracted with Blue Cross NC will be eligible for in-network benefits under our members’ benefit plans. Providers ordering these devices on and after December 1, 2018, for their commercial members are asked to verify the participation status of the supplier. Network-participating DME suppliers can be located using the Find a Doctor, Drug, or Facility search tool available at BlueCrossNC.com .

Before December 1, DME suppliers already participating in Blue Cross NC’s commercial networks will receive letters from us with a request to amend their contracts for insulin pump and CGM inclusion. Providers accepting the amendment will not need to take any action. We hope all suppliers elect to accept the amendment and continue their participation with us. However we’re asking all ordering providers to please verify a DME supplier’s participation status before ordering devices and supplies after November, just in case a participating DME suppliers elects to leave the network.,

(Please note – Blue Cross NC is not asking all DME suppliers to offer insulin pumps or continuous glucose monitors as part of the products or services they offer. Rather, acceptance of an amendment offers the selling and distribution of these supplies as an available option for participating DME suppliers.)

Please contact your Provider Network, Strategic Provider Relationship Consultant with any questions about this change in increased availability of choices for our commercial members’ access to insulin pumps, CGMs, and supplies. And if you have difficulty finding an in-network supplier using the Find a Doctor, Drug, or Facility search tool, please call our Provider Blue LineSM for assistance, at 1-800-214-4844.

The following is a list of codes for insulin pumps, CGMs, and supplies that will become available from participating suppliers starting in December:

Code Insulin Pump, CGM, and Supplies
A4221 Supplies for maintenance of drug infusion catheter, per week
A4230 Infusion set for external insulin pump, non-needle cannula type
A4231 Infusion set for external insulin pump, needle type
A4232 Syringe with needle for external insulin pump, sterile 3CC
A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories
A9276 Sensor, invasive, disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply
A9277 Transmitter, external, for use with interstitial continuous glucose monitoring system
A9278 Receiver (monitor), external, for use with interstitial continuous glucose monitoring system
E0784

External ambulatory infusion pump, insulin

Manufacturer

  • Medtronic
  • Animas, Roche, Tandem (T-Slim)
  • VGO/Insulet (Omnipod)
E0784 (RR) External ambulatory infusion pump, insulin, rental, gestational
K0552 Supplies for external infusion pump, syringe type cartridge sterile, each