Effective for claims dated or after April 1, 2022, CMS creates the following HCPCS code to represent an additional CGM device used in conjunction with an insulin pump: Copyright © 2013 – 2022, The American Hospital Association, Chicago, Illinois. Reproduction by CMS with kind permission. No part of the American Hospital Association (AHA) copyrighted material contained in this publication may be copied without the express written permission of the AHA. AHA copyrighted material, including UB-04 codes and descriptions, may not be removed, copied, or used in any software, products, services, solutions, or derivative works without the written consent of AHA. If a company wishes to use AHA equipment, please contact the AHA at 312-893-6816. Make copies or use the contents of the UB-04 manual, including codes and/or descriptions, for internal purposes, resale and/or use in products or publications; Creation of modified or derivative works of the UB-04 manual and/or codes and descriptions; and/or commercial use of the UB-04 manual or any part thereof, including codes and/or descriptions, is permitted only with an express license from the American Hospital Association. To obtain a license for the UB-04 Data Specifications electronic data file, contact Tim Carlson at (312) 893-6816. You can also contact us at ub04@aha.org. Date of entry into force of the revision: 28.02.2022REQUIREMENTS FOR CERTAIN DMEPOS ARTICLES IN ACCORDANCE WITH FINAL RULE 1713 (84 FED. REG VOL 217):Revised: “provides” to “provide” Deleted: “The link will be found here as soon as it is available.” Added: “The required personal meeting and written order before the delivery list are available here.” with a hyperlink to the list are reminded to suppliers that payment for E2102 (or E1399 for service appointments no later than March 31, 2022) is only available for the CGM receptor function of a rented insulin infusion pump if the recipient does not already have a CGM receptor of any kind. whether (additional or not), who is less than five years old and whose beneficiary does not yet have an insulin pump less than five years old. In addition, switching from an insulin pump without CGM receptor function to an insulin pump with CGM receptor function does not interrupt the period of continuous use of the insulin pump or the start of a new 13-month rent cap for the insulin pump for the recipient. The Supplier transfers ownership of the Equipment to the Beneficiary on the first day following the end of the 13th month of use by the Beneficiary.
The regulation requires the insulin pump supplier to continue to supply the pump for the remainder of the 13-month limited rental period in the first month or until the end of the medical need for the pump, whichever comes first. For claims whose execution date is 1. April 2022, additional CGM available deliveries covered by the EMR benefit (as described in the section COVERAGE OF NON-MEDICAL NECESSITIES AND PAYMENT RULES) must be invoiced with the code A4238 for the pension allowance. To be eligible for Medicare reimbursement, all CGM devices billed K0554 must have received a Contractor`s Coding Verification in Pricing, Data Analytics and Coding (PDAC) and be on the Product Classification List (PCL) for HCPCS code K0554. As of July 1, 2022, all GCMs billed to Medicare with HCPCS code E2102 must have received a PDAC contractor code verification and be listed in the LCP for HCPCS E2102. If a CGM system with HCPCS code K0554 or E2102 (valid from 1. July 2022), but the CGM system is not included in the OBA for the respective HCPCS code, the claim will be rejected as incorrect coding. Products reviewed by PDAC that do not meet the requirements of the EMR benefit category must be coded A9279 and will be rejected as uncovered (no Medicare benefit). For more information, see the CODING GUIDELINES section below.