Guidance related to CGM Billing

[Prakalpb]

Hello,

Can anyone help, how we can submit the claim to insurance.
-Does CGM submission requires date span.
-Is it compulsory to include NU modifier.
- Should equipment needs to be deliver before submitting the claim.
- Which date need to be consider as DOS? 1. Proof of Delivery 2. DWO signed by referring physician.

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.

NU modifier is to indicate items were purchased so if they are purchasing items I would include it.  It may vary by insurance carrier as to whether or not it's required.

The date the patient receives the equipment is the DOS.