CGM BASICS
What does CGM stand for?
Continuous Glucose Monitoring
CGM devices (E0784) can be billed in which two ways?
Rental to Purchase (RR) or Purchased (NU)
RR OR NU
*BONUS* HOW LONG IS RR TIME FRAME?
What must the individual have documented to qualify for CGM medical necessity?
Diabetes mellitus (any type)
Refills for medically necessary disposable external insulin pumps are considered what?
Medically necessary
What must be referenced on your tag?
Member Code and CPT for review:
EXAMPLE 00 E0784 A9276
What CPT code is used to bill a Continuous Glucose Monitor?
E0784
What CPT code is used to bill a CGM sensor?
A9276
What type of education must the individual or caregiver complete?
Comprehensive diabetes education program
Continued pump use is supported if what kind of benefit is shown?
Clinical benefit (improved/stabilized HbA1c or fewer glucose episodes)
Follow format from 10.18.24 huddle agenda
Please specify
OUTCOME: APPROVED/ DENIED
RENTAL / PURCHASE: (MODIFIER) RR OR NU
CPT CODE(S): E0784 A9276
IF DENIED SPECIFY REASON:
INTERNALLY REVIEWED FINDINGS FOR APPROVAL: (this should be presented to Liset ad Veronica with your findings)
specify members qualifications for this approval
EXAMPLE A-C on page 2 of your notes
CGM devices are primarily used by individuals managing what chronic condition?
Diabetes mellitus
How is one unit of A9276 billed?
1 unit = 1 day supply
How many daily insulin injections are required to meet CGM criteria?
Multiple times daily
Name one condition that must be met to replace an external insulin pump
Out of warranty / malfunctioning / cannot be refurbished
Who do I need to send an email to before internally approving?
What should be included in your email?
Liset and Veronica
Your findings from the medical records
What is inserted under the skin to measure glucose levels?
A small sensor
BONUS : WHAT BILLING CODE?
What type of device does A9276 describe?
Invasive (subcutaneous) disposable sensor
CGM medical necessity requires both multiple insulin injections and what kind of testing?
Multiple blood glucose tests daily or CGM use
What must be documented to justify continued CGM use?
Clinical improvement (e.g., better HbA1c)
What do you put on your patient note?
CPT CODE MODIFIER DATE AND REF TO CORRO
What real-time benefit do CGM devices provide to users?
Continuous tracking of glucose levels
True or False: The A9276 supply can be billed for the lifetime of the device.
True
Continued CGM use must show what kind of clinical improvement?
Improved or stable HbA1c or fewer hypo/hyperglycemia episodes
Replacing a CGM still under warranty is considered what?
Not clinically appropriate