MedicaidAdministrativeMedium impact
PT 54-26: Updated Process for Coverage Consideration for Procedures, Devices and Physician Administered Drugs and Biologics
Maryland Medicaid·MD·Managed Care
Effective date
Jan 20, 2026
We identified it
Jun 18, 2026
Summary
Maryland Medicaid has implemented a new centralized Benefit Determination process for requesting coverage of new or expanded procedures, devices, and physician-administered drugs and biologics. All requests must now be submitted through a dedicated webpage using a Cognito Form, and manufacturers/pharmaceutical representatives must have documentation from a Maryland Medicaid-enrolled clinician sponsor.
Action Required
Immediately: If your practice serves Maryland Medicaid patients and needs to request coverage for new procedures, devices, or physician-administered drugs/biologics, use only the new MDH Benefit Determination webpage and Cognito Form submission process. Providers must be prepared to sponsor manufacturer requests with documentation of immediate or justified anticipated clinical need. Contact mdh.marylandbenefitsdetermination@maryland.gov for questions.