MedicaidPrior AuthMedium impact
MMP 23-31: Revisions to Continuous Glucose Monitoring Systems (CGMS) Policy
Michigan Medicaid - MDHHS·MI · Endocrinology, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Jun 1, 2023
We identified it
Jun 20, 2026
Summary
Michigan Medicaid has revised its Continuous Glucose Monitoring Systems (CGMS) policy, removing prior authorization requirements for Type I diabetes and pregnancy-related diabetes while maintaining prior auth for Type II diabetes. New HCPCS codes A4239 and E2103 replace K0553 and K0554 effective January 1, 2023, with updated coverage criteria requiring insulin use and provider documentation.
Action Required
By June 1, 2023: Billing team must update HCPCS codes K0553 to A4239 and K0554 to E2103 in billing system. For existing prior authorizations spanning beyond June 1, 2023, fax change requests to MDHHS Program Review Division at 517-335-0075 to update HCPCS codes. Remove prior authorization requirements for Type I diabetes and diabetes in pregnancy cases. Ensure documentation includes insulin frequency and current treatment plan within 90 days. Update encounter forms to reflect new coverage criteria requiring endocrinologist or diabetes-managing provider care.