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Official Description

Non-adjunctive, non-implanted continuous glucose monitor or receiver
Short Descr Non-adju cgm receiver/mon
Coverage Carrier Priced
Pricing Indicator(s) 32 – Supplies And Surgical Dressings - Inexpensive & routinely purchased DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1E – Other DME
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2023
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 1
MUE 1
OTS Orthotic No
NU New equipment
KX Requirements specified in the medical policy have been met
CG Policy criteria applied
KF Item designated by fda as class iii device
RR Rental (use the 'rr' modifier when dme is to be rented)
KS Glucose monitor supply for diabetic beneficiary not treated with insulin
GW Service not related to the hospice patient's terminal condition
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ Item or service expected to be denied as not reasonable and necessary
KR Rental item, billing for partial month
Date
Action
Notes
2023-01-01 Added Code added.
Code
Description
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