MedicaidCoverageMedium impact
PT 63-26: Updated Coverage of Continuous Glucose Monitoring Systems
Maryland Medicaid·MD · Endocrinology, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Maryland Medicaid is expanding coverage for continuous glucose monitoring (CGM) systems effective January 1, 2026, now including Type 1 and Type 2 diabetes patients on insulin, gestational diabetes patients, and those with problematic hypoglycemia. All CGM requests require preauthorization through Telligen and must meet specific medical criteria including insulin treatment or documented hypoglycemic events.
Action Required
Immediately: Billing team must update CGM prior authorization procedures to use Telligen for all Maryland Medicaid patients. Verify patients meet new expanded criteria (Type 1/2 diabetes on insulin, gestational diabetes, or documented hypoglycemia). Ensure providers document practitioner evaluation within 6 months prior to ordering and sufficient CGM training before prescribing. Reference new policy PT 63-26 and stop using superseded policy PT 06-17.