MedicaidPrior AuthMedium impact
Continuous Glucose Monitors Policy Update and Webinar on Proper CGM Use
Missouri Medicaid (MO HealthNet)·MO · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Notice
Effective date
Jun 15, 2023
We identified it
Jun 20, 2026
Summary
MO HealthNet (Missouri Medicaid) has streamlined CGM approval for participants on any insulin therapy, eliminating the need for prior authorization or manual paperwork. CGMs now receive automated approval for insulin users, significantly simplifying the ordering process.
Action Required
Immediately: Billing team should update workflows for Missouri Medicaid CGM orders - no prior authorization is now required for participants on any insulin therapy (short-acting or basal). Remove PA requirements from billing system for Dexcom G6 and G7 products for MO HealthNet patients on insulin. Verify quantity limits remain: 1 receiver per 310 days, 1 transmitter per 76 days, 3 sensors per 25 days.