Maryland Medicaid: Expanded coverage for CGM systems
AI Summary
Maryland Medicaid expanded coverage for continuous glucose monitoring (CGM) systems effective January 1, 2026, for UnitedHealthcare Community Plan members with diabetes. Providers must evaluate diabetes control within 6 months prior to ordering and submit prior authorization before CGM coverage.
Action Required
Immediately: Billing team and providers must establish workflow to evaluate diabetes control within 6 months before ordering CGM systems for Maryland Medicaid members. Submit prior authorization through UnitedHealthcare Provider Portal using One Healthcare ID. Update EMR templates to document coverage criteria for type 1/type 2 diabetes patients using insulin, gestational diabetes, or problematic hypoglycemic events.
Plan Types
Medicaid
States
MD
Specialties
endocrinology, family-medicine, internal-medicine, ob-gyn