Glucose Monitors

The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.

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Topic Details
Billing Monthly Supply Allowance When a therapeutic CGM (code K0554) is covered, the related supply allowance (code K0553) is also covered.

The supply allowance (code K0553) is billed as 1 Unit of Service (UOS) per thirty (30) days. Only one (1) UOS of code K0553 may be billed to the DME MACs at a time. Billing more than 1 UOS per 30 days of code K0553 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
Diabetic Supplies and Accessories Used with CGM 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 Aug 2021 15:00:55 +0000

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