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.

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