The purchase of a blood glucose monitor may be reimbursed once every three years using the following procedure codes:
Procedure Code
Limitation
E0607
1 per 3 years when billed with an appropriate diagnosis code
E2100
1 per 3 years with prior authorization
E2101
1 per 3 years with prior authorization
Prior authorization is required for blood glucose monitors with special features (procedure codes E2100 and E2101). The following documentation supporting medical necessity of the special feature requested must be submitted with the prior authorization request:
•Integrated voice synthesizer. Supporting documentation for procedure code E2100 must include an additional diagnosis such as significant visual impairment and must include a statement from the physician indicating that the client is unable to use a regular monitor and that the visual impairment is not correctable.
•Integrated lancing/blood sample. Supporting documentation for procedure code E2101 must include a diagnosis of diabetes and significant manual dexterity impairment related, but not limited to, neuropathy, seizure activity, cerebral palsy, or Parkinson's. The documentation must include a statement from the physician indicating that the client is unable to use a regular monitor and has a significant manual dexterity impairment that is not correctable.
Texas Medicaid & Healthcare Partnership CPT only copyright 2009 American Medical Association. All rights reserved.
