Maryland Medicaid: Expanded coverage for CGM systems
AI Summary
Maryland Medicaid expanded coverage for continuous glucose monitoring (CGM) systems effective January 1, 2026, for members with type 1/type 2 diabetes using insulin, gestational diabetes, or problematic hypoglycemic events. Prior authorization is required and providers must evaluate diabetes control within 6 months before ordering CGM.
Action Required
Immediately: For Maryland Medicaid members needing CGM systems, billing team must ensure prior authorization is obtained through UnitedHealthcare Provider Portal before submitting claims. Providers must document evaluation of diabetes control within 6 months prior to CGM order and verify member meets coverage criteria (type 1/2 diabetes using insulin, gestational diabetes, or problematic hypoglycemic events). Update billing workflows to flag CGM orders for prior auth requirements.
Plan Types
Medicaid
States
MD
Specialties
endocrinology, family-medicine, internal-medicine, ob-gyn