Interim Instructions for Individual Claim Adjudication

HCPCS Coding

For purposes of Medicare billing, the Ruling outlines therapeutic CGM as comprising two elements: (1) a DME component and, (2) an all-inclusive supply allowance.   The DME component for the Dexcom G5^® Mobile CGM system is the receiver.  The receiver must be billed using the following code:

E1399 - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS

When billing this code, suppliers must enter "Dexcom G5^® Receiver" in the narrative field of the claim.

The supply allowance for supplies used with the Dexcom G5^® Mobile CGM System encompasses all items necessary for the use of the device and includes, but is not limited to:  CGM sensor, CGM transmitter, home blood glucose monitor and related BGM supplies (test strips, lancets, lancing device, and calibration solutions) and all batteries. The supply allowance must be billed using the following code:

• A9999 – DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS SUPPLY

Claims for A9999 must be billed as one (1) unit of service per month.  When billing this code, suppliers must enter "Supplies used with Dexcom G5^® Receiver" in the narrative field on the claim.

Smart Device Usage

The Medicare DME Benefit excludes coverage for non-medical items, even when the items may be used to serve a medical purpose.  As a result, smart devices (smart phones, tablets, personal computers, etc.) are non-covered by Medicare under this exclusion.  Likewise, medical supplies used with non-covered equipment are not eligible for Medicare reimbursement.

In addition to the DME receiver included in the Dexcom G5^® Mobile CGM System, an alternative option for displaying the received data is with a smart device using the Dexcom G5^® app and a beneficiary-owned smart device such as a smart phone or tablet.   Medicare does not cover a beneficiary-owned smart device.  Claims for beneficiary-owned smart devices submitted to Medicare must be coded:

• A9270 - NONCOVERED ITEM OR SERVICE

Miscellaneous

Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers who provide the Dexcom G5^® Mobile CGM System are reminded of the following Medicare coverage policies:

• Coverage of the CGM system supply allowance is limited to those therapeutic CGM systems where the beneficiary ONLY uses a receiver classified as DME to display glucose data.  If a beneficiary uses a non-DME device (smart phone, tablet, etc.) as the display device, either separately or in combination with a receiver classified as DME, the supply allowance is non-covered by Medicare. 
• Therapeutic CGM devices replace a standard home blood glucose monitor (HCPCS codes E0607, E2100, E2101) and related supplies (HCPCS codes A4233-A4236, A4244-A4247, A4250, A4253, A4255-A4259).  Claims for standard home glucose monitors and all related supplies, billed in addition to a CGM system and associated supply allowance, will be denied as unbundling.

All non-therapeutic CGM systems must be billed with the existing CGM-related HCPCS codes.  At this time, all CGM systems except the Dexcom G5^® Mobile CGM System are classified by CMS as non-therapeutic CGM systems. All non-therapeutic CGM systems must be billed using the following codes: 

• A9276 - SENSOR; INVASIVE (E.G., SUBCUTANEOUS), DISPOSABLE, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM, ONE UNIT = 1 DAY SUPPLY
• A9277 - TRANSMITTER; EXTERNAL, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM
• A9278 - RECEIVER (MONITOR); EXTERNAL, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM

These codes are non-covered by Medicare (no benefit).

For complete information please visit: https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/coding-and-coverage-therapeutic-continuous-glucose-monitors