PDAC Code Verification Reviews for CGM Devices - Coding and Billing - JA DME

Joint DME MAC Publication
Posted March 17, 2022

Effective for claims with dates of service on or after July 1, 2022, the only products that may be billed using Healthcare Common Procedure Coding System (HCPCS) code E2102 (ADJUNCTIVE CONTINUOUS GLUCOSE MONITOR OR RECEIVER) are those that have received mandatory coding verification review by the Pricing, Data Analysis and Coding (PDAC) contractor and are listed on the Product Classification List (PCL). This includes continuous glucose monitor (CGM) devices incorporated into insulin infusion pumps. Manufacturers may submit their products to the PDAC contractor for coding verification review beginning immediately. This guidance applies to any CGM device not previously receiving PDAC code verification review.

As a reminder, products that are billed as K0554 (RECEIVER (MONITOR), DEDICATED, FOR USE WITH THERAPEUTIC GLUCOSE CONTINUOUS MONITOR SYSTEM) also require a coding verification review by the PDAC contractor. This requirement for products coded as K0554 has been effective since July 1, 2017.

If you have questions, please contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative or select the Contact Us button at the top of the PDAC website for email, FAX or postal mail information.

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