January 26, 2024
Important Billing Reminder for A4258/Spring-Powered Device for Lancet – Blood Glucose Monitors – Revised
Are your claims rejecting with ANSI Reason Code CO-16, ANSI Remark Code M59?
The "to" date of service on this claim was either missing or was greater than 180 days beyond the "from" date. All claims must include both a "from" and "to" date of service, even if they are the same date. The date span between the "from" and "to" dates cannot be greater than 180 days.
CGS has identified recent claim submission errors involving the spring-powered device for lancet, each (A4258) when billed with a span date.
Effective April 18, 2022, HCPCS code A4258 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.
Please ensure your billing staff is taking the appropriate steps when submitting claims for HCPCS code A4258.
When billing HCPCS code A4258:
- The date of service for HCPCS code A4258 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 6 months as long as it is reasonable and necessary.
| From Date: MM DD YY | To Date: MM DD YY | HCPCS | Units of Service |
|---|---|---|---|
| 4/18/22 | 4/18/22 | A4258 | 1 |
We encourage you to use the DMEPOS Requiring Claim Span Dates & Claim Narratives Chart
, which outlines DMEPOS items that require claim span dates and claim narratives.
Additional Resources:
- JC Supplier Manual – Chapter 3 Supplier Documentation
- JC Supplier Manual – Chapter 6 Claim Submission
- Refer to the Local Coverage Determination (LCD) Article Glucose Monitors
for complete information about payment rules, policy specific documentation requirements, modifiers, and coding guidelines.
Publication History
| March 21, 2022 | Originally Published |
| January 26, 2024 | Revised to remove refill information due to guideline changes effective January 1, 2024. |
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