RETIRED - Billing Instructions - Continuous Glucose Monitors - JD DME
RETIRED - Billing Instructions - Continuous Glucose Monitors
Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.
Joint DME MAC Article
Posted on April 20, 2017
Questions have arisen about the proper billing of continuous glucose monitors (CGM) and the related supply allowance. The following instructions apply to all claims for CGM and related supplies.
- All claims must be billed with codes E1399 for the therapeutic CGM receiver and A9999 for the supply allowance. Only one (1) month of the supply allowance (one (1) Unit of Service) may be billed to the DME MACs at a time.
- All claims must include the diagnosis code that describes the beneficiary's disease condition.
Modifier KX or KS must be added to the claim line for the therapeutic CGM receiver and supply allowance code:
- Use modifier KX if the beneficiary is insulin treated; or,
- Use modifier KS if the beneficiary is non-insulin treated.
- Modifier CG must be added to the claim line for the therapeutic CGM receiver and supply allowance code if all of the coverage requirements are met. If any of the coverage requirements for a therapeutic CGM are not met, modifier CG must not be used.
- All claims for devices classified by Medicare as non-therapeutic CGM devices and related supplies must be billed using codes A9276, A9277 and A9278.
- All claims for non-therapeutic CGM devices must include the diagnosis code that describes the beneficiary's disease condition.
- Modifiers KX, KS and CG are not used when billing non-therapeutic CGM devices and related supplies.
Refer to the March 23, 2017 DME MAC joint publication titled "Coding and Coverage – Therapeutic Continuous Glucose Monitors (CGM)" for additional coverage, coding and documentation requirements. The Glucose Monitors Local Coverage Determination and Related Policy Article will be updated with this information in a future revision.
Last Updated Thu, 10 Jan 2019 12:34:48 +0000