RETIRED - Glucose Monitors LCD and Related Policy Article - Revised

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.

Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Joint DME MAC Article

Posted on May 18, 2017

The Glucose Monitors Local Coverage Determination (LCD) and Related Policy Article has been revised, effective for claims with dates of service on or after January 12, 2017, the date of CMS Ruling 1682R on continuous glucose monitors (CGM).  The LCD and related Policy Article also includes new HCPCS codes (see below) for therapeutic CGM and the related supply allowance.  These two new codes have a future effective date for claims with dates of service on or after July 1, 2017.  

The revision incorporates the following updates related to therapeutic continuous glucose monitors (CGM):

1. Adds new HCPCS codes for therapeutic CGMs and the related supply allowance:

  • K0553 - SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE
  • K0554 - RECEIVER (MONITOR), DEDICATED, FOR USE WITH THERAPEUTIC CONTINUOUS GLUCOSE MONITOR SYSTEM 

2. Adds coverage, coding and documentation requirements for therapeutic CGMs (K0554) and their related supply allowance (K0553).

3. Adds information about billing the supply allowance (K0553). 

4. Adds modifier information when billing for therapeutic CGMs (K0554) and their related supply allowance (K0553):

  • Use modifier KX if the beneficiary is insulin treated; or,
  • Use modifier KS if the beneficiary is non-insulin treated;
  • Use modifier CG if all of the coverage requirements are met.

5. Moved the Standard Documentation Language to a separate Standard Documentation Requirements Article (A55426) as an attachment to the LCD and related Policy Article.

Suppliers should pay particular attention to the claim date of service and the proper HCPCS codes used to bill the therapeutic CGM receiver and supply allowance. 

  • Dates of Service Prior to July 1, 2017:
    • Therapeutic CGM - E1399
    • Supply Allowance - A9999
  • Dates of Service On or After July 1, 2017:
    • Therapeutic CGM – K0554
    • Supply Allowance – K0553

Suppliers should refer to the following articles for additional information on the coverage, coding and documentation requirements for CGM devices and the supply allowance:

  • Coding and Coverage – Therapeutic Continuous Glucose Monitors (CGM) (March 23, 2017)
  • Billing Instructions – Continuous Glucose Monitors (April 20, 2017)

 

Last Updated Dec 11 , 2023