Two New “K” Codes for Therapeutic Continuous Glucose Monitors

By: Christina Colegrove RN, BSN – Clinical Consultant

Change Request (CR) 10013 provides the addition of 2 new “K” codes for therapeutic Continuous Glucose Monitors (CGM) to the Healthcare Common Procedure Coding System (HCPCs).  The effective date is July 1, 2017 and the implementation date is July 3, 2017 for the following 2 codes:

  • K0553: Supply allowance for CGM, includes all supplies and accessories (1 unit of service is equal to 1 month’s supply)
  • K0554: Receiver (Monitor), dedicated, for use with CGM

 

Continuous glucose monitoring systems are considered therapeutic CGMs/DME if the equipment:

  • Is approved by the Food and Drug Administration (FDA) for use in place of a blood glucose monitor for making diabetes treatment decisions (such as changes in diet or insulin dosage)
  • Is generally not useful to the individual in the absence of illness or injury
  • Is appropriate for use in the home
  • Includes a durable component (component that CMS determines can withstand repeated use with expected lifetime of at least 3 years) that is able to display continuous glucose measurements trends

The addition of K0553 and K0554 will facilitate Durable Medical Equipment (DME) MAC claims processing for therapeutic CGMs.

Resources:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10013.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3751CP.pdf