Article Detail - JD DME
Continuous Glucose Monitor (CGM) Alert: What You Need to Know Following April 1 Code Changes
Noridian has observed trending claim submission errors that result in claim denials since the allowance for billing both adjunctive and non-adjunctive CGM.
These trends include:
- Missing KX and CG modifier
- Incorrect infusion pump on file
- Therapeutic CGM (K0554) already on file
Noridian would like to remind suppliers of the joint DME MAC publication Continuous Glucose Monitors - Correct Coding and Billing - Revised that thoroughly outlines the requirements for both adjunctive CGM and non-adjunctive CGM.
Non-adjunctive CGM provision, coverage requirements and billing have not changed. Existing HCPCS K0554 (Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system) and K0553 (Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit or service) remain in place.
Adjunctive CGM devices were assigned code E2102 (Adjunctive continuous glucose monitor or receiver) effective April 1, 2022. When providing and billing for E2102, there must be accompanying billing for E0784 (External ambulatory infusion pump, insulin) as well. Additionally, code A4238 (Supply allowance for adjunctive continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service) should be used when billing accessories for the adjunctive CGM.
Finally, modifiers CG (all coverage criteria met), KF (Class III devices), and KX (insulin treated) are required as appropriate when billing CGM devices.