We’re sharing a quick reminder of our allowed continuous glucose monitor (CGM) authorization timeframes by plan type:
- Commercial: 12 months
- Medicaid: 12 months
- Medicare: 6 months
We’ve recently received a few 6-month CGM authorization requests for members with commercial and Medicaid plans. We want to make sure you’re aware that last October, we updated our requirements for commercial and Medicaid CGM authorization requests and no longer require a new authorization with proof of provider visit every 6 months. You may submit your CGM authorizations for these members for 12 months at a time.
We made this change to help ensure our members with diabetes get the care they need when they need it, with as few barriers as possible.
Per CMS LCD requirements, Medicare CGM requests may be submitted for 6 months.