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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.24 Continuous Glucose Monitoring (CGM)

9.2.24
CGM (procedure codes 95250 and 95251) is a benefit of Texas Medicaid with prior authorization.
Procedure codes 95250 and 95251 are limited to once per 12 calendar months by any provider.
The rental or purchase of a continuous glucose monitoring system (CGMS) is considered part of the CGM and is not reimbursed separately.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.