Glucose Monitor Modifiers: CG, KF, KS, and KX

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)
  • 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).

Last Updated Jun 20 , 2022