Are Your Patients Running Out of Supplies for Their Continuous Glucose Monitor?

Pharmacies often struggle with audits for DMEPOS items. The Medicare Part B/DMEPOS billing model is a complex maze of units, codes and documentation requirements that are very different from billing traditional prescription drugs. This model produces high error rates and recoupments across the country. You must have a strong understanding of these differences to prevent audit recoupment. This article discusses how to bill supplies for Continuous Glucose Monitors (CGMs).

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  • When a CGM Receiver/Monitor code of K0554 is covered, the related supply “allowance” code K0553 is also covered
  • A monthly supply allowance includes all supply items needed for the patient to use the non-adjunctive CGM. These supply items may include transmitters, sensors, batteries, strips, lancets, and control solution for a Blood Glucose Monitor (BGM)
  • Use the following steps to prevent patients from running out of supplies before month end
    • Only bill 1 unit of service (UOS) for HCPCS code K0553 per month
    • 1 UOS equals 1 month’s supply no matter if 28, 29, 30 or 31 days in the month
    • If using a FreeStyle Libre, providing 2 (14-day) sensor packs will leave the patient short on days 29, 30 or 31
    • The following example from the Medicare Learning Network®  is a way to ensure the patient has enough supplies per calendar month
      • April – 30 calendar days: Provide 3 sensors (42-day supply)
      • May – 31 calendar days: Proved 2 sensors (28-day supply) since the patient should have 12 days remaining from the previous month
      • June – 30 calendar days: Provide 2 sensors (28-day supply) since the patient should have 9 days remaining from the previous month
    • Pharmacy will need to dispense 3 (14-day) sensors twice per calendar year
    • Check with patients often to see what supplies they need and send enough to meet the next month’s supply need
    • Remember, Medicare pays a bundled rate for the 1 UOS each month so you are still getting paid for the two extra sensors provider through the year. See the July 2021 Newsline article, Are You Billing Continuous Glucose Monitors Correctly?

Jennifer Ottman, CPhT
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