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Michigan: The MCT2D CGM prior auth bypass will end on Jan. 1
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 1, 2026
Summary
UnitedHealthcare's prior authorization bypass pilot program for continuous glucose monitors (CGM) in type 2 diabetes patients ends January 1, 2027. After this date, CGM prescriptions will require standard prior authorization and must meet UnitedHealthcare's coverage criteria. Members prescribed CGM on or before December 31, 2026, will retain bypass status for 12 months or until December 31, 2027, whichever comes first.
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What to do
by Dec 31, 2026 · 5 steps
01Billing team must prepare for prior authorization requirement resumption for CGM prescriptions.
02Update billing system rules to require prior authorization for all CGM prescriptions written after January 1, 2027, for type 2 diabetes patients.
03Identify and document all current CGM patients prescribed under MCT2D pilot to ensure their 12-month bypass extension is properly tracked in the system through December 31, 2027.
04Educate providers and front desk staff that CGM prior authorization will be mandatory starting January 1, 2027, and provide them access to UnitedHealthcare's standard CGM coverage criteria.
05Establish workflow to submit prior authorizations through the UnitedHealthcare Provider Portal before dispensing CGMs to new patients.
If missed: Failure to obtain prior authorization after the deadline will result in claim denials for CGM devices and related supplies.
Original notice
Michigan: The MCT2D CGM prior auth bypass will end on Jan. 1
uhcprovider.com · Always check the source before changing claims.