Attend a Webinar
- CERT Reduction Initiative - Glucose Monitors
- 06/25/19
- Continuous Glucose Monitors
Glucose Monitors
Coverage
- Glucose Monitors and Testing Supplies Local Coverage Determination (LCD) and Policy Article [PDF]
- Home Blood Glucose Monitors National Coverage Determination (NCD)
Documentation
- Clinician Documentation Requirements - Blood Glucose Strips and Lancets [PDF] - Letter may be used as communication tool between suppliers and clinicians to ensure documentation compliance for DMEPOS claims and audits
- 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 - Home Blood Glucose Monitor (BGM) [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 Suppliers Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
- Patient Documentation Form - Insulin Using [PDF] - Patients using insulin may bring this letter to clinicians to help them in medical record documentation
- Patient Documentation Form - Non-Insulin Using [PDF] - Patients not using insulin may bring this letter to clinicians to help them in medical record documentation
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
Tips
| Topic | Details |
|---|---|
| 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 Mar 25, 2019
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.
Continuous Glucose Monitors Webinar - June 27, 2019 May 15, 2019
CGM Supply and Accessory Claims Being Rejected Oct 09, 2018
Dear Physician Letter - Continuous Glucose Monitor - June 2018 DMD Jun 22, 2018
Continuous Glucose Monitors - Use of Smart Devices DMD Jun 21, 2018
Policy Article Revision Summary for June 21, 2018 DMD Jun 21, 2018
Two New K Codes for Therapeutic Continuous Glucose Monitors - Revised CR10013 May 30, 2017
Glucose Monitors LCD and Related Policy Article - Revised DMD May 18, 2017
Continuous Glucose Monitors - Frequently Asked Questions DMD May 04, 2017
Billing Instructions - Continuous Glucose Monitors DMD Apr 20, 2017
Coding and Coverage - Therapeutic Continuous Glucose Monitors (CGM) DMD Mar 23, 2017
Updated Glucose Monitors and Supplies Physician Letter DMD Sep 03, 2015