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CGM supply billing

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Michele:
Could you please help me with the billing guidelines for K0553 (CGM Supplies), i.e. frequency is 1 month supply = 1 unit of service.
1. Then what should be FROM and TO dates in claim needs to mention?
2. Do we need to use NU Modifier.
3. Criteria to use KS, KX & CG Modifier in CGM billing.

Thank You!

Michele:
If it is a one month supply you would use just the purchased date as the from and to dates.

As for the NU modifier, it may vary by insurance carrier if it is required or not.  I haven't billed CGM supplies so I'm not sure, but it shouldn't hurt to have it so I would include it.

The KS modifier would be used to indicate that the patient is not being treated with insulin injections.

The KX modifier would be used to indicate that the supplier ensured coverage criteria.

The CG modifier would be used to indicate that preventitive services were furnished during the visit.

Prakalpb:
Hello Michelle,

Thank you!!!

Just need to confirm few more things.
As you mentioned in previous post, "For one month suppy, we would use purchased date as from and to date" so it would like-  date on which Dr. (patient's PCP) has signed the prescription or the date where equipment has been delivered.
In addition, could you please confirm, should we deliver the equipment prior submitting claim to insurances.
Secondly, CGM won't be an rental services as it would be one month supply, so whether there would be possibilities of Same & Similar.

Thank You!!

Michele:
You would use the date that they received the equipment as both the to and from.  You would not use the date the PCP signed the prescription.

You would need to provide the equipment prior to submitting the claim since the claim is stating that the patient received the services.  You can do a predetermination if you are concerned about whether it will be paid.

I'm not sure if you asked a third question.

Prakalpb:
Hello,

We are currently billing for CGM. i.e. K0554 & K0553. We are delivering Free style Libre 14 days product to the patients. And while submitting we are utilizing delivery date as DOS.

However we require your assistance to understand one process.
       - As Free style Libre 14 days - Sensor can be utilized for 14 days, so while delivering we are delivering three quantities to meet the
         Medicare guidelines i.e. 1 unit/ 30 days.
       - However if we deliver the product quarterly i.e. 7 quantity to meet 90 days period and bill monthly then while submitting second
         month sensor i.e. K0553 which DOS we should consider because if we consider actual delivery date then it would get denied as
         Duplicate because the same DOS was utilized for First month.

Could you please suggest on this, how we can bill to the insurance.

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