The document discusses the changes to coding for Continuous Glucose Monitoring (CGM) in the state of New York. The changes include the restoration of previously deleted codes and new codes for non-adjunctive and adjunctive CGM systems. The codes are categorized into deleted and new codes, with descriptions, fees, and frequencies listed. The document also explains the differences between non-adjunctive and adjunctive CGM systems and the codes to be used with each. Additionally, it provides guidance on the reimbursement process for pharmacy providers dispensing CGM supplies.
CGM Reimbursement
CGM supplies found on the Preferred Diabetic Supply Program should be reimbursed through this program. For other CGM systems, providers should submit requests for prior approval or authorization to the Department’s Bureau of Medical Review through the Dispensing Validation System (DVS). Contact information is provided for questions regarding CGM prior approval, coverage guidelines, and the Preferred Diabetic Supply Program.
New Codes
New codes include E2103F4 for non-adjunctive, non-implanted continuous glucose monitor or receiver, A4239F9 for supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), and A4238F9 for supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm). The document also lists deleted codes, including K0553 and K0554.
Manual:
Download: Correction 2023 Coding Changes for Continuous Glucose Monitoring
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