Glucose Monitors - JA DME
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.
Coverage
- Glucose Monitors and Testing Supplies Local Coverage Determination (LCD) and Policy Article [PDF]
- Home Blood Glucose Monitors National Coverage Determination (NCD)
Documentation
- Clinician Checklist Continuous Glucose Monitors [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Glucose Monitors and Related Supplies [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Continuous Glucose Monitors Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
- Clinician Letter - Continued Medical Necessity [PDF] - Clinician directed letter that reminds them that ongoing need for and use of DMEPOS item must be documented in patient's medical record
- Clinician Letter - Glucose Monitors and Supplies [PDF] - Clinician directed letter that advises them as to what type of documentation is necessary in medical records to support payment of glucose monitors and related supplies
- Clinician Letter - Therapeutic Continuous Glucose Monitor (CGM) [PDF] - Clinician directed letter that advises them as to what type of documentation is necessary in medical records to support payment of glucose monitors and related supplies
- Glucose Monitors and Related Supplies Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
Tips
| 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:
|
| 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
Related Articles
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.