Author Topic: CGM supply billing  (Read 2963 times)

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
CGM supply billing
« on: December 30, 2019, 04:06:36 PM »
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!
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: CGM supply billing
« Reply #1 on: December 31, 2019, 10:46:52 AM »
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.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Prakalpb

  • Newbie
  • *
  • Posts: 20
Re: CGM supply billing
« Reply #2 on: January 02, 2020, 03:35:09 PM »
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

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: CGM supply billing
« Reply #3 on: January 06, 2020, 09:30:26 AM »
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.

Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Prakalpb

  • Newbie
  • *
  • Posts: 20
Re: CGM supply billing
« Reply #4 on: January 29, 2020, 01:01:07 PM »
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.

Medical Billing Forum

Re: CGM supply billing
« Reply #4 on: January 29, 2020, 01:01:07 PM »

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: CGM supply billing
« Reply #5 on: January 29, 2020, 04:41:27 PM »
I'm confused.  If you are delivering quarterly wouldn't your delivery dates be something like 1/1/2020 7 units, 4/1/2020 7 units, 7/1/2020 7 units and 10/1/2020 7 units?
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Prakalpb

  • Newbie
  • *
  • Posts: 20
Re: CGM supply billing
« Reply #6 on: March 03, 2020, 01:35:49 PM »
Could you please help us with the modifier to Bill HCPCS code E0651. We would be delivering this equipment and it would be purchase. Also, this particular E0651 could be for right leg or Left leg. So accordingly could you please help with the modifier to bill

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: CGM supply billing
« Reply #7 on: March 03, 2020, 03:05:17 PM »
There is not enough information to help you.  You give no indication as to why you need a modifier and what the modifier would be indicating.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Prakalpb

  • Newbie
  • *
  • Posts: 20
Re: CGM supply billing
« Reply #8 on: March 03, 2020, 03:31:54 PM »
Also,

E0651 "Pneumatic compressor, segmental home model without calibrated gradient pressure" for which body part this can be used like leg or arm

Prakalpb

  • Newbie
  • *
  • Posts: 20
Re: CGM supply billing
« Reply #9 on: March 03, 2020, 03:58:48 PM »
There is not enough information to help you.  You give no indication as to why you need a modifier and what the modifier would be indicating.

We would be delivering this equipment directly to patient as a purchase and this won't be a rental service.

Medical Billing Forum

Re: CGM supply billing
« Reply #9 on: March 03, 2020, 03:58:48 PM »

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: CGM supply billing
« Reply #10 on: March 09, 2020, 09:41:05 AM »
 

Common modifiers

RR - Rental
NU - Purchase of new equipment
UE - Purchase of used equipment
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Prakalpb

  • Newbie
  • *
  • Posts: 20
DME services supplies.
« Reply #11 on: April 16, 2020, 03:24:31 PM »
I am willing to get enrolled my facility with Medicare in order to do so,
Could you please help with the requirement list (pre-requisite in physical location)  which is involved in physical location, for successfully completing the site/ physical verification for Medicare.

Thank You!

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: CGM supply billing
« Reply #12 on: April 17, 2020, 11:54:55 AM »
Are you saying that you would like to enroll a facility with Medicare?  You don't give enough information and aren't clear with your question.  I would visit www.cms.gov for more information on the requirements.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Prakalpb

  • Newbie
  • *
  • Posts: 20
Re: CGM supply billing
« Reply #13 on: April 17, 2020, 06:32:25 PM »
Hello,

We are starting a new DME supplier and we would like to enroll with Medicare. As per Medicare we require Physical location to get certified from site verification. So just wanted to understand what are the requirements criteria ( necessary equipments needs to be stored in location, what sq metres the area location should be) under Physical location to get passed by Medicare.

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: CGM supply billing
« Reply #14 on: April 20, 2020, 04:36:18 PM »
The following gives information on what to expect during a site inspection:  https://www.palmettogba.com/palmetto/providers.nsf/ls/National%20Supplier%20Clearinghouse~AFQLMT4106?opendocument

I'm not familiar with any requirements on the size of the facility, or what equipment is needed.  I don't believe that is what they are looking at. 

These articles also have some good information:

https://blog.sellerscommerce.com/what-is-a-dme-supplier-and-how-to-become-a-dme-supplier

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/DMEPOSEnrollment

Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Medical Billing Forum

Re: CGM supply billing
« Reply #14 on: April 20, 2020, 04:36:18 PM »