icd 10 code for continuous glucose monitoring

Full Answer

What is the purpose of a blood glucose monitor?

Purpose[edit] Blood glucose monitoring reveals individual patterns of blood glucose changes, and helps in the planning of meals, activities, and at what time of day to take medications.[2] Also, testing allows for quick response to high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). ...

What is ICD 10 for poorly controlled diabetes?

In ICD-10-CM, chapter 4, "Endocrine, nutritional and metabolic diseases (E00-E89)," includes a separate subchapter (block), Diabetes mellitus E08-E13, with the categories:

• E08, Diabetes mellitus due to underlying condition
• E09, Drug or chemical induced diabetes mellitus
• E10, Type 1 diabetes mellitus
• E11, Type 2 diabetes mellitus
• E13, Other specified diabetes mellitus

What is considered prediabetes A1C ICD 10?

Prediabetes

• R73.03 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2022 edition of ICD-10-CM R73.03 became effective on October 1, 2021.
• This is the American ICD-10-CM version of R73.03 - other international versions of ICD-10 R73.03 may differ.

What is a constant glucose monitor?

Continuous glucose monitoring is a method of, well, continuously monitoring the glucose in your body. It involves placing a tiny sensor just under your skin that measures your glucose levels, transmitting this information to an external monitor.

How do you bill for continuous glucose monitoring?

CPT code 95249 - Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training and printout of recording.

What is a continuous glucose monitor called?

Continuous glucose monitoring (CGM) devices help you manage Type 1 or Type 2 diabetes with fewer fingerstick tests. A sensor just under your skin measures your glucose levels 24 hours a day. A transmitter sends results to a wearable device or cell phone.

What is the CPT code for freestyle Libre sensor?

CPT code 95250 is for placing the sensor, hook-up, monitor calibration, patient training, removing the sensor, and printing out the recording.

What is the CPT code for dexcom?

Who can perform and bill CPT code 95251?

What are the different types of CGM?

There are 3 common CGM systems currently on the market in the US: the Dexcom G6, the Freestyle Libre system from Abbott, and the Medtronic's Guardian Sensor 3. The Dexcom G6 is the current CGM system from Dexcom.

Is dexcom a flash continuous glucose monitor?

Both Dexcom G6 CGM and Freestyle Libre 2 Flash Glucose Monitoring System can measure glucose levels continuously and translate the readings into data on your compatible device. However, Dexcom G6 offers continuous glucose data in real-time with no scanning required.

What is ambulatory continuous glucose monitoring?

Description. A continuous glucose monitor (CGM) is a minimally invasive device that is designed to measure and record glucose levels continuously and automatically in a patient. The device measures glucose values in the interstitial fluid of subcutaneous tissue.

What is the CPT code for blood glucose monitor?

A. Yes, providers should continue to use CPT code 95251 for the analysis and interpretation of continuous glucose monitor (CGM) data. CPT code 95250 is used for the initial training and set-up of the CGM.

What is CPT code A9276?

A9276 - SENSOR; INVASIVE (E.G. SUBCUTANEOUS), DISPOSABLE, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM, ONE UNIT = 1 DAY SUPPLY.

What is the ICD 10 code for diabetes?

E08. 3531 Diabetes mellitus due to underlying condition... E08. 3532 Diabetes mellitus due to underlying condition...

What is the HCPCS code for Dexcom G6?

K0553Product Classification List Search ResultsProductNameManufacturer/DistributorHCPCS CodeDEXCOM G6 CONTINUOUS GLUCOSE MONITORING SYSTEM (CGM)DEXCOM INCK0553 + K0554FREESTYLE LIBRE 2 FLASH GLUCOSE MONITORING SYSTEMABBOTT DIABETES CARE INCK0554FREESTYLE LIBRE 2 FLASH GLUCOSE MONITORING SYSTEMABBOTT DIABETES CARE INCK05547 more rows

Is dexcom considered DME?

The CMS Ruling deter- mined that the Dexcom G5 receiver was considered the durable component meeting the defintion of DME. With that designation as DME, the disposable sensor and transmitter Page 3 get covered as supplies to the covered DME.

What is a CGM device?

Continuous glucose monitoring (CGM) devices measure glucose in the interstitial fluid, not capillary blood, providing interstitial glucose readings every few minutes. CGM systems are composed of several components — disposable sensors that are inserted in the subcutaneous tissue, a transmitter that relays information to the receiver, and a receiver where the information is displayed.

Is CGM considered precautionary equipment?

Consequently, CGM devices are considered precautionary equipment. The Medicare Durable Medical Equipment Benefit excludes precautionary items from coverage; therefore, claims for CGM systems are denied as statutorily non-covered, no benefit.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..

Article Guidance

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) Implantable Continuous Glucose Monitors (I-CGM).

ICD-10-CM Codes that Support Medical Necessity

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

General Information

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..

Article Guidance

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38662 Implantable Continuous Glucose Monitors (I-CGM). Please refer to the LCD for reasonable and necessary requirements.

ICD-10-CM Codes that Support Medical Necessity

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.

ICD-10-CM Codes that DO NOT Support Medical Necessity

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article. Group 1 Codes:

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

Which insurance companies cover CPT codes?

National payers such as Cigna, Humana, Aetna, United Healthcare and Anthem WellPoint are currently covering these CPT codes, although the coverage criteria may differ between personal and professional use of CGM.

Is CGM reimbursement successful?

CGM has truly been a reimbursement success story. There are established CPT codes for providers to get paid and broad coverage within the payer community. Download the 2021 CGM Reimbursement reference sheet.

Does Medicare cover training costs for CGM?

(Medicare does not currently reimburse for a CGM system if a smart device is solely used to display glucose data. The patient must have a receiver to use in conjunction with the smart device.)