CommercialCoverageMedium impact
Continuous Glucose Monitoring (1.01.20)
Blue Shield of California·CA · Endocrinology, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Apr 1, 2026
Summary
Blue Shield of California updated their Continuous Glucose Monitoring policy effective April 1, 2026, establishing specific medical necessity criteria for CGM coverage including requirements for insulin-dependent diabetes with 3+ daily insulin doses and devices with audible/tactile alarms. The policy also adds coverage criteria for implanted CGM devices and gestational diabetes monitoring.
Action Required
Before April 1, 2026: Billing team must update prior authorization processes for continuous glucose monitoring to verify patients meet new criteria: insulin-dependent diabetes requiring 3+ daily insulin doses AND CGM device has audible/tactile alarms. Update documentation requirements for implanted CGM (age 18+, contraindication to transdermal devices). Add gestational diabetes CGM coverage for pregnant patients ≥18 years. Claims will be denied if medical necessity criteria are not met.