CGM Basics
What fluid do CGMs measure glucose from?
Interstitial fluid
What HCPCS code is used for non-adjunctive CGM receivers?
E2103
What does the CG modifier indicate?
Policy criteria applied
What condition must a beneficiary have to qualify for CGM coverage?
Diabetes mellitus
What spreadsheet is used to check CGM history?
Beneficiary History Spreadsheet
Name one Medicare-approved CGM device.
Dexcom G6, Freestyle Libre 2, etc.
What does HCPCS code E2102 represent?
Adjunctive, non-implanted CGM receiver
What does the KS modifier mean?
Diabetic beneficiary not treated by insulin
What is the 5-year rule for CGM replacement?
CGM cannot be replaced before 5-year RUL
What must match between documentation and claim?
Beneficiary name
What are the three components of a CGM system?
Sensor, transmitter, receiver
What is the role of the receiver in a CGM system?
Displays glucose readings
What does the KF modifier indicate?
What is one documented hypoglycemia event that qualifies for CGM coverage?
Level 2 or 3 hypoglycemic event
What must be included in a Standard Written Order (SWO)?
Beneficiary name, order date, item description, quantity, practitioner name/NPI, signature
What is the difference between adjunctive and non-adjunctive CGMs?
Adjunctive requires fingerstick; non-adjunctive does not
What does the EY modifier indicate?
No physician order present
What does the KX modifier confirm?
Medical policy requirements met
What type of visit must occur within 6 months of CGM order?
In-person or telehealth visit
What is the consequence of an illegible signature with no attestation?
Claim may be denied
What CMS ruling classifies CGMs as DME?
CMS Ruling 1682-R
What document outlines correct CGM billing and coding?
PDAC Coding Guide
What modifier is used when an ABN is issued?
GA
What must the practitioner conclude about the beneficiary’s training?
Practitioner must confirm beneficiary is trained
What reason code is used when no documentation is received?
GDW40