Provider Alert! Prior Authorization Update for Continuous Glucose Monitoring
Date: April 20, 2021
Attention: All Providers
Effective Date: April 20, 2021
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Texas Children’s Health Plan would like to inform network providers that short-term continuous glucose monitoring service Procedure Codes 95250 and 95251 will require prior authorization effective April 20, 2021. These codes are applicable for diagnostic purposes or short term use as in Type diabetes during pregnancy or for determining modifications to a treatment plan. These codes are a benefit once in a 12 month period. Click here for the Continuous Glucose Monitoring Prior Authorization Guideline.
How this impacts providers: Providers should adhere to the prior authorization requirements for short-term continuous glucose monitoring Procedure Codes 95250 and 95251. The prior authorization form is available here.
Next steps for providers: Provides should share this prior authorization update with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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