October 26, 2021 – Updated 11.04.21
Revised: CGM Supply Allowance (K0553) Billed with a Span Date: Claims Will Be Denied
CGS has identified recent claim submission errors involving the supply allowance (K0553) used with therapeutic continuous glucose monitors (CGMs) when billed with a span date.
Effective November 15, 2021, HCPCS code K0553 billed with a span date will be returned as unprocessable. Unprocessable claims must be corrected and resubmitted; they do not have appeal rights or the ability to be reopened or adjusted.
When billing HCPCS K0553:
- The date of service for HCPCS K0553 should not be billed with a span date. The "From" and "To" date fields on the claim should be the same.
- No more than 1 unit of service is billable for each date of service.
- The code is billable every 30 days.
From Date: MM DD YY To Date: MM DD YY HCPCS Units of Service 11/15/21 11/15/21 K0553 1
- The code is billable every 30 days.
CGS created a new online tool for DMEPOS suppliers: K0553 Billing Calculator. The billing calculator will assist with determining K0553 subsequent billing dates.
Additional resources:
- Billing Reminders for Continuous Glucose Monitors (CGMs) Supply Allowance (K0553)
- DMEPOS Requiring Claim Span Dates & Claim Narratives
- Advanced Modifier Engine (online tool)
Refer to the Local Coverage Article Glucose Monitor – Policy Article (A52464) for complete information about payment rules, policy specific documentation requirements, modifiers, and coding guidelines.