Continuous Glucose Monitor Supplies - Correct Coding and Billing

Joint DME MAC Article

The DME MACs have recently noticed an increase in denials for HCPCS code K0553 (SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE) due to suppliers billing more frequently than once per month (e.g., billing K0553 every 28 days). Suppliers must not bill more than one (1) unit of service of HCPCS code K0553 per thirty (30) days.

Information about billing of K0553 may be found in the Glucose Monitors LCD-related Policy Article (A52464). As a reminder, the Glucose Monitors Policy Article states (emphasis added):

For claims with dates of service on or after July 1, 2017, a therapeutic CGM must be billed with code K0554 and code K0553 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.

Code K0553 describes a supply allowance used with a therapeutic CGM device. The supply allowance includes all items necessary for the use of the device and includes, but is not limited to: CGM sensor, CGM transmitter, home BGM and related BGM supplies (test strips, lancets, lancing device, calibration solutions) and batteries. K0553 must not be used for supplies used with CGM coded as A9278.

A supplier does not have to deliver supplies used with a therapeutic CGM every month in order to bill code K0553 every month. In order to bill code K0553, the supplier must have previously delivered quantities of supplies that are sufficient to last for one (1) full month following the DOS on the claim. Suppliers must monitor usage of supplies. Billing for code K0553 may continue on a monthly basis as long as sufficient supplies remain to last for one (1) full month as previously described. If there are insufficient supplies to be able to last for one (1) full month, additional supplies must be provided before the supply allowance is billed.

No more than 1 unit of service (UOS) for code K0553 per month is billable at a time.

Therefore, in order to avoid denials for excess utilization, suppliers must ensure that they are billing for no more than one (1) UOS of K0553 per thirty (30) days. Refer to the Glucose Monitors LCD (L33822) and related Policy Articles (A52464 and A55426) for additional coverage, coding and documentation requirements.