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CSHCN Services Program Provider Manual Update for Continuous Glucose Monitors

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On December 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Chapter 15: Diabetic Equipment and Supplies, section 15.2.2, “Continuous Glucose Monitors (CGM),” to clarify benefit language for CGMs.

Only CGM systems that include the sensor, transmitter, and a dedicated receiver and monitor are a benefit of the CSHCN Services Program. To be considered for prior authorization, the make and model of a requested device must be included on the complete, detailed written prescribing provider’s orders and the CSHCN Services Program Prior Authorization Request for Diabetic Equipment and Supplies Form.

A CGM system that uses a smart device, such as a smartphone, tablet, watch, or personal computer, as a receiver is not classified as durable medical equipment (DME) and will not be reimbursed by the CSHCN Services Program.

If inadequate or incomplete information is provided or medical necessity is lacking, the provider will be asked to furnish any required or additional documentation so that a decision about the request can be made.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.