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Updates to Diabetic Equipment and Supplies Benefit Information Effective March 1, 2024

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after March 1, 2024, some benefit information for diabetic equipment and supplies will be updated for Texas Medicaid.

Clarification for Types of CGMs

The general term continuous glucose monitor (CGM) refers to both non-adjunctive (formerly referred to as therapeutic) and adjunctive (formerly referred to as non-therapeutic) CGMs.

A non-adjunctive CGM can be used to make treatment decisions without the need for a stand-alone blood glucose monitor (BGM) to confirm testing results.

An adjunctive CGM requires the user to verify their glucose levels or trends displayed on a CGM with a BGM before making treatment decisions.

Requirements of Durable Medical Equipment (DME) Certification and Receipt Form

The DME Certification and Receipt Form must include the following:

  • The name of the item that the client has received and the date that it was received.
  • The name of any separate receiver or monitor that the client has received, if applicable.
  • The printed names and signatures of the provider and the client or primary caregiver.

Note: The make and model of the item will no longer be required.

For more information, call the TMHP Contact Center at 800-925-9126.