{"id":15340,"date":"2022-04-11T18:34:35","date_gmt":"2022-04-11T18:34:35","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15340"},"modified":"2025-10-16T07:40:22","modified_gmt":"2025-10-16T07:40:22","slug":"medicare-rn-requirements-for-glucose-monitors","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/","title":{"rendered":"Medicare R&#038;N Requirements for Glucose Monitors"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit. In order for a beneficiary\u2019s DME to be eligible for reimbursement, the reasonable and necessary (R&amp;N) requirements set out in the related Local Coverage Determination (LCD) must be met. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">In addition, there are specific statutory payment policy requirements, that also must be met.<\/span> <span style=\"font-weight: 400;\">Information provided in this article relates to determinations other than those based on Social Security Act \u00a71862(a)(1)(A) provisions (i.e., \u201creasonable and necessary\u201d).<\/span> <span style=\"font-weight: 400;\">For any item to be covered by Medicare, it must<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">be eligible for a defined Medicare benefit category,\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">meet all other applicable Medicare statutory and regulatory requirements.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">On or after January 12, 2017, Medicare began coverage of therapeutic CGM devices under the DME benefit. CGM devices covered by Medicare were defined in CMS Ruling 1682R as therapeutic CGMs. A therapeutic or non-adjunctive CGM can be used to make treatment decisions without the need for a stand-alone BGM to confirm testing results. A non-therapeutic or adjunctive CGM requires the user to verify their glucose levels or trends displayed on a CGM with a BGM prior to making treatment decisions.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">On February 28, 2022, CMS determined that both therapeutic\/non-adjunctive and non-therapeutic\/adjunctive CGMs may be classified as DME. CGM devices that solely display results on a smartphone and do not have a stand-alone receiver or integration into an insulin infusion pump do not meet the definition of <a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/durable-medical-equipment-medical-billing-services.html\">DME<\/a> and will be denied as non-covered (no benefit). <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The supply allowance for supplies used with a CGM system (K0553, A4238) encompasses all items necessary for the use of the device and includes but is not limited to, CGM sensors and transmitters.\u00a0<\/span><span style=\"font-weight: 400;\">For non-adjunctive CGMs, the supply allowance (K0553) also includes a home BGM and related supplies (test strips, lancets, lancing device, calibration solution, and batteries), if necessary. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Supplies or accessories billed separately will be denied as unbundling. For adjunctive CGMs, the supply allowance (A4238) encompasses all items necessary for the use of the device and includes but is not limited to, CGM sensors and transmitters.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Applicable Modifiers\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">For blood glucose monitors (codes E0607, E2100, E2101) and related supplies (codes A4233, A4234, A4235, A4236, A4244, A4245, A4246, A4247, A4250, A4253, A4255, A4256, A4257, A4258, A4259) and CGM devices (code K0554 or E2102) and supply allowance (code K0553 or A4238), the following modifiers must be added to the code(s) on every claim submitted:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Use modifier KX if the beneficiary is insulin-treated; or,<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Use modifier KS if the beneficiary is non-insulin treated<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CG modifier must be added to the claim, only if all of the CGM coverage criteria in the Glucose Monitor LCD are met<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CGMs (K0554 and E2102) and related supplies (A4238 and K0553) which are classified by the Food &amp; Drug Administration as Class III devices must include the KF modifier.<\/span><\/li>\n<\/ul>\n<p><b>Medical Billers and Coders (MBC)<\/b><span style=\"font-weight: 400;\"> is a <a href=\"https:\/\/www.medicalbillersandcoders.com\/\">leading medical billing company<\/a> providing complete revenue cycle services. We shared Medicare reasonable and necessary (R&amp;N) requirements for glucose monitors for reference purposes only, our article doesn\u2019t guarantee any payment. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">We can assist you in Medicare billing and coding for your practice. To know more about our billing and coding services, contact us at <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a>\/ <a href=\"tel:888-357-3226\"><strong>888-357-3226<\/strong><\/a><\/span><\/p>\n<p><span style=\"font-weight: 400;\">*CPT Copyright American Medical Association. All rights reserved. CPT\u00ae is a registered trademark of the American Medical Association (AMA).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Reference: <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/article.aspx?articleId=52464\">Glucose Monitor &#8211; Policy Article<\/a><\/span><\/p>\n<h2>FAQs<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1760600267089\"><strong class=\"schema-faq-question\">1. What is required for Medicare coverage of blood glucose monitors (BGMs) and continuous glucose monitors (CGMs)?<\/strong> <p class=\"schema-faq-answer\">To be covered, BGMs and CGMs must meet Medicare&#8217;s &#8220;reasonable and necessary&#8221; requirements and comply with local coverage determinations (LCDs).<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1760600286050\"><strong class=\"schema-faq-question\">2. What is the difference between therapeutic and non-therapeutic CGMs?<\/strong> <p class=\"schema-faq-answer\">Therapeutic CGMs can make treatment decisions without a separate BGM, while non-therapeutic CGMs require a BGM to verify results before treatment.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1760600299181\"><strong class=\"schema-faq-question\">3. Can CGMs that only display results on a smartphone be covered by Medicare?<\/strong> <p class=\"schema-faq-answer\">No, CGMs that display results solely on a smartphone without a stand-alone receiver or insulin pump integration are not covered by Medicare.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1760600310623\"><strong class=\"schema-faq-question\">4. What does the supply allowance for CGMs cover?<\/strong> <p class=\"schema-faq-answer\">The supply allowance covers all necessary items for using the CGM, including sensors, transmitters, test strips, and related accessories.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1760600318637\"><strong class=\"schema-faq-question\">5. Which modifiers are required for CGM claims?<\/strong> <p class=\"schema-faq-answer\">Use modifier KX for insulin-treated beneficiaries, KS for non-insulin-treated beneficiaries, and CG for meeting all CGM coverage criteria, with KF for Class III devices.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit. In order for a beneficiary\u2019s DME to be eligible for reimbursement, the reasonable and necessary (R&amp;N) requirements set out in the related Local Coverage Determination (LCD) must be met. In addition, there are specific statutory payment [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":15341,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[666,790,3354,146,3355,3356,3357,3358],"class_list":["post-15340","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dme-billing-services","tag-american-medical-association","tag-dme","tag-glucose-monitors","tag-medicare-2","tag-medicare-billing-and-coding","tag-medicare-billing-and-coding-for-your-practice","tag-medicare-rn","tag-medicare-rn-requirements-for-glucose-monitors"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.0 (Yoast SEO v28.0) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Medicare R&amp;N Requirements for Glucose Monitors<\/title>\n<meta name=\"description\" content=\"We shared Medicare (R&amp;N) requirements for glucose monitors for reference purposes only, our Blog doesn\u2019t guarantee any payment.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medicare R&amp;N Requirements for Glucose Monitors\" \/>\n<meta property=\"og:description\" content=\"We shared Medicare (R&amp;N) requirements for glucose monitors for reference purposes only, our Blog doesn\u2019t guarantee any payment.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/\" \/>\n<meta property=\"og:site_name\" content=\"Medical Billing and RCM Blogs\" \/>\n<meta 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The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/medicare-rn-requirements-for-glucose-monitors\\\/#faq-question-1760600267089\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/medicare-rn-requirements-for-glucose-monitors\\\/#faq-question-1760600267089\",\"name\":\"1. What is required for Medicare coverage of blood glucose monitors (BGMs) and continuous glucose monitors (CGMs)?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"To be covered, BGMs and CGMs must meet Medicare's \\\"reasonable and necessary\\\" requirements and comply with local coverage determinations (LCDs).\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/medicare-rn-requirements-for-glucose-monitors\\\/#faq-question-1760600286050\",\"position\":2,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/medicare-rn-requirements-for-glucose-monitors\\\/#faq-question-1760600286050\",\"name\":\"2. What is the difference between therapeutic and non-therapeutic CGMs?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Therapeutic CGMs can make treatment decisions without a separate BGM, while non-therapeutic CGMs require a BGM to verify results before treatment.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/medicare-rn-requirements-for-glucose-monitors\\\/#faq-question-1760600299181\",\"position\":3,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/medicare-rn-requirements-for-glucose-monitors\\\/#faq-question-1760600299181\",\"name\":\"3. 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Which modifiers are required for CGM claims?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Use modifier KX for insulin-treated beneficiaries, KS for non-insulin-treated beneficiaries, and CG for meeting all CGM coverage criteria, with KF for Class III devices.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Medicare R&N Requirements for Glucose Monitors","description":"We shared Medicare (R&N) requirements for glucose monitors for reference purposes only, our Blog doesn\u2019t guarantee any payment.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/","og_locale":"en_US","og_type":"article","og_title":"Medicare R&N Requirements for Glucose 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What is required for Medicare coverage of blood glucose monitors (BGMs) and continuous glucose monitors (CGMs)?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"To be covered, BGMs and CGMs must meet Medicare's \"reasonable and necessary\" requirements and comply with local coverage determinations (LCDs).","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600286050","position":2,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600286050","name":"2. What is the difference between therapeutic and non-therapeutic CGMs?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Therapeutic CGMs can make treatment decisions without a separate BGM, while non-therapeutic CGMs require a BGM to verify results before treatment.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600299181","position":3,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600299181","name":"3. Can CGMs that only display results on a smartphone be covered by Medicare?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No, CGMs that display results solely on a smartphone without a stand-alone receiver or insulin pump integration are not covered by Medicare.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600310623","position":4,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600310623","name":"4. What does the supply allowance for CGMs cover?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The supply allowance covers all necessary items for using the CGM, including sensors, transmitters, test strips, and related accessories.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600318637","position":5,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-rn-requirements-for-glucose-monitors\/#faq-question-1760600318637","name":"5. 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