Glucose Monitors

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Continuous Glucose Monitor (CGM)

Billing Monthly Supply Allowance
When a CGM (codes K0554/E2102) are covered, the related supply allowance (codes K0553/A4238) are also covered.

The supply allowance (codes K0553/A4238) are billed as 1 Unit of Service (UOS) per thirty (30) days. Only one (1) UOS of code K0553 or A4238 may be billed to the DME MACs at a time. Billing more than 1 UOS per 30 days of code K0553 or A4238 will be denied as not reasonable and necessary.

Because CGM supplies sometimes come as a 14-day supply kit, below is an example of billing the monthly supply allowance.

Example:
  • First month - Provide three kits of supplies during month: 3 x 14-day supply = 42-day supply - Bill one supply allowance fee. Will have 12 days of supplies left over for next month
  • Second month - Provide two kits of supplies during month: 2 x 14-day supply = 28-day supply - Bill one supply allowance fee. Will have 10 days of supplies left over for next month
  • Third month - Provide two kits of supplies during month: 2 x 14-day supply = 28-day supply - Bill one supply allowance fee. Will have 8 days of supplies left over for next month
  • Fourth month - Provide two kits of supplies during month: 2 x 14-day supply = 28-day supply - Bill one supply allowance fee. Will have 6 days of supplies left over for next month
See the Continuous Glucose Monitor: Provide Supplies for a Calendar Month MLN Connects for more details.
Diabetic Supplies Used with Blood Glucose Monitor (BGM) and Continuous Glucose Monitor (CGM) Claims for dates of service (DOS) on/after March 1, 2020, for BGM supply HCPCS codes, K0553, or A4238 must require one of the below.
  • A claim on file for HCPCS E0607, E2100, E2101, K0554, or E2102
    OR
  • A narrative within Item 19 of CMS-1500 Claim Form or its electronic equivalent indicating beneficiary owned HCPCS E0607, E2100, E2101, K0554, or E2102 and its approximate purchase date
    • Example: Beneficiary owned E0607. Purchased 09/15/2021
If there is no glucose monitor in the Medicare claims history or the narrative is missing, the claim will deny as missing the equipment that requires the supply.
Diabetic Supplies and Accessories Used with CGM K0554 Must be billed to the DME MAC with HCPCS K0553. The supply allowance includes all items necessary for the use of the device and includes, but is not limited to: CGM sensor, CGM transmitter, home BGM and related BGM supplies (test strips, lancets, lancing device, calibration solutions) and batteries. One unit of service equals a one-month supply to be used with the CGM. These supplies shall not be billed individually or with a National Drug Code (NDC). Suppliers should work with their billing/software vendors to ensure individual supplies/codes are consolidated into HCPCS K0553. See CMS Medicare Learning Network (MLN) Matters (MM)10013 for details.

 

Last Updated Thu, 05 May 2022 19:53:16 +0000

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