MedicaidCoverageMedium impact
MSA 19-04
Michigan Medicaid - MDHHS·MI · Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Apr 1, 2019
We identified it
Jun 20, 2026
Summary
Michigan Medicaid will begin covering continuous glucose monitoring systems (CGMSs) for Type I diabetes patients starting April 1, 2019. Prior authorization is required for patients over age 5, with specific documentation requirements including provider qualifications, patient compliance, and diabetes self-management education completion.
Action Required
By April 1, 2019: Billing team must update system to recognize new CGMS coverage for Michigan Medicaid patients with Type I diabetes. Add prior authorization requirements for patients over age 5. Update encounter forms to ensure providers document all required criteria including diabetes self-management education completion, hypoglycemic events, and treatment compliance. Configure frequency limits for each HCPCS code (A9276: 30/month, A9277: 2/year, A9278: 1/3 years, K0553: 1/month, K0554: 1/3 years).