TMPPM 2008 > Texas Medicaid Services > Texas Medicaid (Title XIX) Home Health Services > Benefits

24.5.12.2 Blood Glucose Monitors

A blood glucose monitor is a portable battery-operated meter used to determine the level of blood sugar (glucose). Home glucose monitor procedure codes J-E0607, J-E2100, and J-E2101 are benefits of Home Health Services and are allowed reimbursement once every five years.

Prior authorization is not required for the purchase of a standard blood glucose monitor (J-E0607), but is limited to the diagnoses listed in the diagnosis table above. Diagnoses not listed may be considered for prior authorization with supporting documentation of medical necessity.

Invasive continuous glucose monitors (CGMs) are used for diagnostic purposes to assist the clinician in establishing or modifying a client's treatment plan. Invasive CGMs are not benefits of Home Health Services. Noninvasive CGMs are considered investigational and are not benefits of the Texas Medicaid Program.

Prior authorization for blood glucose monitors with special features (procedure codes J-E2100 and J-E2101), such as auditory responses for visually impaired clients may be considered with documentation that supports the medical necessity of the special feature that was requested. This can be requested either by calling TMHP Home Health Services Prior Authorization Department, or by faxing the Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form to TMHP Home Health Services Prior Authorization Department.

To avoid unnecessary denials, physicians must provide correct and complete information, including documentation of the medical necessity of the equipment and/or supplies that are requested. Physicians must maintain documentation of medical necessity in the client's medical record. Requesting providers may be asked for additional information to clarify or complete a request for diabetic equipment or supplies.

Purchase of a blood glucose monitor with integrated voice synthesizer (J-E2100) may be prior authorized with documentation that includes a diagnosis of diabetes and significant visual impairment, including a statement from the physician that the client is unable to use a regular monitor and that the visual impairment is not correctable.

Purchase of a blood glucose monitor with integrated lancing/blood sample (J-E2101) may be prior authorized with documentation that includes a diagnosis of diabetes and significant manual dexterity impairment related to, but not limited to, neuropathy, seizure activity, cerebral palsy, or Parkinson's. The documentation must include a statement from the physician that the client is unable to use a regular monitor and has a significant manual dexterity impairment that is not correctable.

The documentation and a completed Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form must be submitted to the Home Health Services Prior Authorization Department.