Correction to Continuous Glucose Monitoring (CGM) Authorization Criteria in TMPPM
AI Summary
Texas Medicaid corrected an unintended change to CGM prior authorization criteria. Effective April 1, 2026, clients must be insulin-treated or have documented history of problematic hypoglycemia to qualify for CGM benefits - reverting to the original requirements that were mistakenly changed in November 2025.
Action Required
By April 1, 2026: Billing team must update prior authorization protocols for CGM claims to require documentation that Texas Medicaid patients are either insulin-treated or have documented history of problematic hypoglycemia. Review TMPPM section 2.2.12.7.1 for complete criteria. Contact patient's specific MCO for managed care authorization procedures as requirements may vary by plan.
Plan Types
Medicaid
States
TX
Specialties
endocrinology, family-medicine, internal-medicine, pediatrics