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24.5.12.1 Blood Testing Supplies
Blood testing supplies for diagnoses other than those listed in the diagnosis table below may be considered for prior authorization with documentation of medical necessity. Quantities will be prior authorized based on the documentation of medical necessity related to the number of tests ordered per day by the physician.
Quantities of blood testing supplies beyond those listed in the procedure code table below for diabetic supplies and limitations, when requested for a diagnosis listed in the diagnosis table below, may be considered for prior authorization with documentation of medical necessity related to the number of tests the physician ordered per day. Blood testing supplies will be reimbursed for the quantities listed in the procedure code table below for diabetic supplies and limitations, or the quantity that was prior authorized.
The quantity of blood testing supplies billed for a one month supply should relate to the number of tests ordered per day by the physician.
Note: THSteps-eligible clients who qualify for medically necessary services beyond the limits of this home health benefit will receive those services through THSteps-CCP. Glucose tabs/gel may be billed with procedure code 9-A9150.
Blood glucose test/reagent strips (9-A4253) and home glucose disposable monitors with test strips (9-A9275) are limited to a combined total of four per month without prior authorization.
Diabetic Supplies and Limitations
Diagnosis Codes
Diagnoses not listed above may be considered by HHSC with supporting documentation of medical necessity.
Diabetic supplies and related testing equipment do not require prior authorization unless otherwise specified by HHSC.
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