Guidance on Diabetic Self-Management Education (DSME)

Anthem Blue Cross and Blue Shield (Anthem) in Ohio and the Ohio Managed Care Organizations (MCOs) are working collaboratively to make diabetes management easier for providers and their patients. Diabetes education and support for the use of continuous glucose monitors (CGMs) have proven to be effective in diabetes care management.

To facilitate increased utilization of these enhanced tools, Anthem and the other MCOs will pay an enhanced rate to providers rendering Diabetes Self-Management Education (DSME) and billing the appropriate codes: G0108 and G0109. In addition, PA is not required for members who receive a covered CGM device through durable medical equipment (DME) providers or through their pharmacy. Providers must use HCPCS codes A4239 and E2103 for CGMs provided through DME.

Services rendered in 2023 should be submitted without delay to prevent denials

For additional information regarding these updates, including who to contact at each MCO for questions, see the quick reference guide on our provider website.