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Effective January 1, 2023, claims submitted to Medicare for continuous glucose monitor (CGM) receivers, supplies and accessories using codes K0553 and K0554 will be rejected. These codes are discontinued on 12/31/2022. Suppliers that provide CGM devices and supplies to Medicare beneficiaries will now be required to submit claims using the appropriate “A codes”.

Per CMS, effective January 1, 2023, fees were deleted for the following codes:

• K0553 and K0553 KF from the DMEPOS fee schedule file and cross-walked to new code and modifier combinations A4239 and A4239 KF.

• K0554 and K0554 KF from the DMEPOS fee schedule file and cross-walked to new code and modifier combinations E2103 and E2103 KF.

Additionally, the code descriptors for adjunctive CGM codes A4238 and E2102 are revised to add “non-implanted” to clarify use with no associated changes to the Class III code/modifier KF fee schedule amounts on the DMEPOS fee schedule file:

• A4238 - Supply allowance for adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
• E2102 - Adjunctive, non-implanted continuous glucose monitor or receiver

These revisions are effective January 1, 2023.

Also going into effect on January 1, 2023, suppliers may submit claims for HCPCS codes A9276, A9277 and A9278 codes in order to get a Medicare denial for the claim.

CMS has also revised code descriptors for:

• A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply
• A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
• A9278 Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system

These changes are a result of updates to the Medicare DMEPOS final rule, published on December 28, 2021. This rule expanded the classification of DME to a larger group of non-implantable CGMs,  regardless of whether the CGMs are non-adjunctive (can alert patients when glucose levels are  approaching dangerous levels, including while they sleep and also replace blood glucose monitors) or adjunctive (can alert patients when glucose levels may be approaching dangerous levels, including while they sleep but don’t replace blood glucose monitors), as long as the CGMs otherwise satisfy the regulatory definition of DME.

Effective April 1, 2022, CMS added codes A4238 and E2102 to the HCPCS file to describe adjunctive CGM receivers and supplies and accessories. More information on the coding and payment for adjunctive CGMs is in the April 2022 DMEPOS Fee Schedule CR 12654.

A narrative summary for the B1 2022 Non-Drug and Non-Biological Items and Services Coding Cycle is available. The effective date for coding changes for new and revised CGM codes A4238, A4239, A9276, A9277, A9278, E2102, E2103, K0553, K0554 is delayed from October 1, 2022, until January 1, 2023.

Do you currently provide CGM devices and supplies to your patients or are you considering adding on this product category?

The van Halem Group team is here to help you! Let our team of experts provide you with education and training to ensure you understand coverage and documentation requirements. We also provide clinical prescreen review services of your claims prior to billing! Our expert clinical staff will review the documentation to determine all requirements have been met prior to dispensing the products to assure compliance with all requirements. This reduces unnecessary risk of claim denials or overpayments. Our reviews can also be used as educational tools with referral sources and transfers some of the burden of being a “difficult provider” to us.

Our Clinical Prescreens are per file fees and based upon complexity.   

Want to know more? Contact us today!