Idaho Medicaid: New billing changes for diabetes equipment and supplies

To comply with recent updates made by Idaho Medicaid, effective April 1, 2026, billing of supplies related to insulin administration and blood glucose monitoring will change from the member’s medical benefit to their pharmacy benefit.

Billing guidelines

For claims with dates of service between Jan. 1, 2026, and March 31, 2026, you can bill through either the member’s medical or pharmacy benefits. Claims submitted to both benefits are subject to review by the Medicaid Program Integrity Unit.
For claims with dates of service on or after April 1, 2026, you’ll need to bill them through the member’s pharmacy benefits otherwise the claim will be denied

Codes moving to pharmacy

This change will apply to the following HCPCS codes:

HCPCS code	Description
A4206	Syringe with needle, sterile, 1 cc or less, each
A4211	Supplies for self-administered injections
A4238	Supply allowance for adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
A4239	Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
A4245	Alcohol wipes, per box
A4250	Urine test or reagent strips or tablets (100 tablets or strips)
A4253	Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
A4256	Normal, low and high calibrator solution/chips
A4258	Spring-powered device for lancet, each
A4259	Lancets, per box of 100
A4271	Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests
A9275	Home glucose disposable monitor, includes test strips
A9276	Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, 1 unit = 1 day supply
A9277	Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
A9278	Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
E0607	Home blood glucose monitor
E0784-SC	External ambulatory infusion pump, insulin
E2100	Blood glucose monitor with integrated voice synthesizer
E2101	Blood glucose monitor with integrated lancing/blood sample
E2102	Adjunctive, non-implanted continuous glucose monitor or receiver
E2103	Non-adjunctive, non-implanted continuous glucose monitor or receiver
E2104	Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge