![]() ![]() Special Instructions Regarding Insulin Pumps that Can Also be Used as CGM Receivers ![]() Total payments for the CGM receiver (any combination of rental or purchase claims) cannot exceed the purchase fee schedule amount. HCPCS modifier RR should be used on any claims for rental of a CGM receiver, while HCPCS modifiers NU and UE should be used on any claims for the purchase of a new (NU) or used (UE) CGM receiver. Details on this process will be provided in the near future.ĬGM receivers can be rented or furnished on a lump sum purchase basis. Final HCPCS coding and national Medicare pricing for adjunctive CGMs will be part of an upcoming HCPCS public meeting, so the agency may consider public feedback. Effective for claims with dates of service on or after April 1, 2022, suppliers should use new HCPCS codes E2102 (Adjunctive continuous glucose monitor or receiver) to submit claims for adjunctive CGM receivers and HCPCS code A4238 (Supply allowance for non-implantable adjunctive continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service) to submit claims for the monthly supplies for adjunctive CGMs.īeginning with claims with dates of service on or after February 28, 2022, local fee schedule amounts for the adjunctive CGM receiver and monthly supplies shall be gap-filled by the DME Medicare Administrative Contractors (DME MACs) as discussed in the final rule. Medicare claims for the monthly supplies for non-adjunctive CGMs are submitted using HCPCS code K0553.Įffective for claims with dates of service from Februthrough March 31, 2022, suppliers should use HCPCS code E1399 (Durable medical equipment, miscellaneous) to submit claims for adjunctive CGM receivers and HCPCS code A9999 (Miscellaneous DME supply or accessory, not otherwise specified) to submit claims for the monthly supplies for adjunctive CGMs. Medicare claims for non-adjunctive CGM receivers are submitted using code K0554 in the Healthcare Common Procedure Coding System (HCPCS). Non-adjunctive CGM receivers, which are DME that displays and monitors the continuous glucose readings and trends, replace a blood glucose monitor for use in making diabetes treatment decisions. CGMs that do not replace a blood glucose monitor are referred to as adjunctive CGMs because they can be used as an adjunct to the blood glucose monitor by showing trends in glucose levels and alerting the patient about potentially dangerous levels, even while they sleep, that then must be verified by use of a separate blood glucose monitor. The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule that takes effect on Februand classifies non-implantable continuous glucose monitors (CGMs) as durable medical equipment (DME) regardless of whether the CGM has been approved or cleared by the Food and Drug Administration (FDA) to replace a blood glucose monitor for use in making diabetes treatment decisions. Information Regarding Implementation of Recent Rulemaking Addressing Classification of Adjunctive Continuous Glucose Monitors as Durable Medical Equipment (Revised) Less than 3,000 claims are affected by these errors and will be automatically reprocessed by the DME MACs. Most of the corrections to the fee schedule amounts were minor resulting in an estimated aggregate underpayment of about $3,200 dollars in 2022 with percentage fee adjustments ranging from 0.5% to 5.1% for the certain items. The revised 2022 public use files are now available: View the Revised DMEPOS Fee Schedule Files. A list of 179 HCPCS code and modifier combinations affected by the revisions is included as a separate public use file under the link below. Virgin Islands)ĬMS identified errors in the fee schedule amounts for certain items furnished in non-contiguous areas and has released revised public use fee schedule files. Corrections Being Made to the 2022 DMEPOS Fee Schedule Amounts for Certain Items Furnished in Non-contiguous Areas (Alaska, Hawaii, Puerto Rico, and the U.S. ![]()
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