MedicaidPrior AuthMedium impact
Updates to Coverage of Continuous Glucose Monitors (CGMs)
Missouri Medicaid (MO HealthNet)·MO · OB-GYN, Endocrinology, Family Medicine +1 more·Provider Notice
Effective date
Aug 29, 2024
We identified it
Jun 20, 2026
Summary
MO HealthNet (Missouri Medicaid) is expanding CGM coverage to include participants with gestational diabetes, effective August 29, 2024. CGM claims will auto-approve for gestational diabetes patients without requiring prior authorization, similar to current coverage for insulin-using participants.
Action Required
Before August 29, 2024: Billing team must update systems to recognize that MO HealthNet participants with gestational diabetes can receive CGMs without prior authorization. Ensure pharmacy claims include appropriate gestational diabetes diagnosis codes. Verify billing staff understand auto-approval applies to both insulin-using patients and gestational diabetes patients.