Article Detail - JD DME

Blood glucose monitors

• (E0607, E2100, E2101) and related supplies (A4233, A4234, A4235, A4236, A4244, A4245, A4246, A4247, A4250, A4253, A4255, A4256, A4257, A4258, A4259)

Continuous Glucose Monitor (CGM) devices

• (K0554 or E2102) and supply allowance (K0553 or A4238)

Modifiers required on every claim submitted (apply to claim line)

• KX - Use if the beneficiary is insulin treated
• KS - Use if the beneficiary is non-insulin treated
• CG - Must be added for CGM device (K0554) and supply allowance (K0553)
  • Only if all CGM coverage criteria (1-5) in the Glucose Monitors LCD (L33822) are met
• CG - Must be added for an adjunctive CGM (E2102) incorporated into an insulin infusion pump and supply allowance (A4238) ONLY if all CGM coverage criteria (1-5) in the Glucose Monitors LCD, and coverage criteria for an insulin infusion pump outlined in External Infusion Pumps LCD (L33794) are met
• KF - Must be added for devices classified by Food & Drug Administration as Class III for CGMs (K0554, E2102) and related supplies (A4238, K0553)

This information on can be found in the Glucose Monitors Policy Article (A52464).