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By Kim Turner, RN

A Continuous Glucose Monitor device (CGM), HCPCS K0554, is covered by Medicare under the DME benefit. When a therapeutic CGM is covered, the related supply allowance (code K0553, SUPPLY ALLOWANCE FOR CGM, INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE) is also covered. However, the DME MACs have recently noticed an increase in denials for HCPCS code K0553 due to suppliers billing more frequently than once per month (example: supplier is billing K0553 every 28 days).

Billing Reminder for HCPCS K0553- The supply allowance (code K0553) is billed as 1 Unit of Service (UOS) per month. Only one (1) UOS of code K0553 may be billed to the DME MACs at a time. Billing more than 1 UOS per month of code K0553 will be denied as not reasonable and necessary.

To avoid denials for excess utilization, suppliers must ensure that they are billing for no more than one (1) unit of service of HCPC K0553 per thirty (30) days.

Questions about billing and documentation requirements for CGM devices?

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