MedicaidPrior AuthMedium impact
Correction to Continuous Glucose Monitoring (CGM) Authorization Criteria in TMPPM
Texas Medicaid·TX · Endocrinology, Family Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Mar 25, 2026
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.