Article Detail - JA DME

For blood glucose monitors (codes E0607, E2100, E2101) and related supplies (A4233-A4236, A4244-A4247, A4250, A4253-A4259) and CGM devices (K0554, E2102) and supply allowance (K0553, A4238), the following modifiers must be added to the code(s) on every claim submitted.

• Use modifier KX if the beneficiary is insulin treated, or
• Use modifier KS if the beneficiary is non-insulin treated.

For CGM devices (code K0554) and the supply allowance (code K0553):

• CG modifier must be added to the claim line only if all CGM coverage criteria (1-5) in Glucose Monitors LCD L33822 are met.

For an adjunctive CGM (E2102) incorporated into an insulin infusion pump and supply allowance (code A4238):

• CG modifier must be added to the claim line only if all CGM coverage criteria (1-5) in Glucose Monitors LCD L33822 are met, and
• Coverage criteria for an insulin infusion pump outlined in External Infusion Pumps LCD L33794 are met.

CGMs (K0554 and E2102) and related supplies (A4238 and K0553) which are classified by the Food & Drug Administration as Class III devices:

• Must include the KF modifier.
• This information on can be found in the Glucose Monitor Policy Article A52464.