New HCPCS Codes for Continuous Glucose Monitoring Devices (IB 22-29)

Date: 09/08/22

Louisiana Healthcare Connections would like to share that effective for dates of service on or after October 1, 2022, two additional Healthcare Common Procedure Coding System (HCPCS) will be added to the DME fee schedule for coverage of adjunctive continuous glucose monitors (CGM), receivers and supplies in the DME program. The first procedure code will cover both the monitor and receiver. The second procedure code will cover the supplies. Reimbursement for both HCPCS codes will be established via manual pricing based on the Medicare rate, MSRP or provider invoices.

The new HCPCS codes are:

• E2102 A valid 2022 HCPCS code for adjunctive continuous glucose monitor or receiver or “adju cgm receiver/monitor.”
• A4238 A valid 2022 HCPCS code for supply allowance for adjunctive continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service or “adju cgm supply allowance.”

Beneficiaries must provide medical documentation to confirm medical necessity based on the published criteria in the DME Provider Manual.

Questions regarding fee-for-service claims should be directed to Gainwell Technologies Provider Relations at (800) 473‐2783 or (225) 924‐5040. Providers can also contact their dedicated Provider Network Specialist at 1-866-595-8133.