Article Detail - JD DME

For blood glucose monitors (codes E0607, E2100, E2101), related supplies (codes A4233, A4234, A4235, A4236, A4244, A4245, A4246, A4247, A4250, A4253, A4255, A4256, A4257, A4258, A4259), Continuous Glucose Monitors (CGM) devices (code E2103 or E2102), and supply allowance (code A4239 or A4238), specific modifiers must be added to the code(s) on every claim submitted.

Use modifier KX if the beneficiary is insulin treated or use modifier KS if the beneficiary is non-insulin treated. Only when all of the CGM coverage requirements (1–5) in the Glucose Monitors Local Coverage Determination (LCD) are satisfied may the CG modifier be applied to the claim line for CGM devices (code E2103) and the supply allowance (code A4239).

The CG modifier must be added to the claim line for an adjunctive CGM (E2102) incorporated into an insulin infusion pump and supply allowance (code A4238) only if all the CGM coverage criteria (1-5) in the Glucose Monitors LCD and the coverage criteria for an insulin infusion pump as outlined in the External Infusion Pumps LCD L33794 are met.

The KF modifier is required for CGMs (E2103 and E2102) and associated supplies (A4239 and A4238) that the Food and Drug Administration (FDA) has designated as Class III devices. This information on can be found in the Glucose Monitor Policy Article A52464 on the CMS website.