New prior authorization for CGM

We will begin requiring prior authorization for personal long–term continuous glucose monitors (CGM) used for the management of type 2 intensive insulin and gestational diabetes. The durable medical equipment (DME) vendor or other rendering provider that has received a physician order for a CGM is required to obtain prior authorization.

This requirement will take effect for UnitedHealthcare Community Plan, Medicaid, Long-Term Care, and Medicare-Medicaid (MMP) plan members: 

• Effective May 1, 2021, in Hawaii, Kentucky*, Maryland, Michigan, Ohio, Pennsylvania, Virginia and Wisconsin
• Effective June 1, 2021, in Arizona, California, Kansas, Massachusetts and Washington* 
• Effective July 1, 2021, in Florida, New York, Rhode Island and Texas

*HCPCS code expansion of existing program requirements in Kentucky and Washington will deploy on listed dates.

More information

• Find the HCPCS codes that require prior authorization
• On May 1, 2021, you can find the policies at  Medical & Drug Policies and Coverage Determination Guidelines for Community Plan

PCA-1-21-00418-Clinical-LTR