TO: DME Providers, Prosthetics & Orthotics (P&O) Providers,
Pharmacies, Physicians,
Physician Assistants, Nurse Practitioners
RE: Durable
Medical Equipment (DME) Program Updates Related to Continuous Glucose Monitor
(CGM) Update
Effective April 12, 2021, providers dispensing a CGM will need to
bill a specific modifier for each brand of CGM. Please see the below table for
more information. Providers submitting prior authorizations (PA) on or after
date of service April 12, 2021, should include the appropriate modifier on the
PA. No changes are being made to the current PA policy or criteria.
|
Brand of CGM
|
Modifier
|
|
Dexcom
|
SC
|
|
Freestyle
|
U6
|
For more information regarding CGM billing, please refer to
Chapter 14 of the Provider Billing Manual at the following link: https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals/7.6.1.1G_Jan2021.aspx.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2021
American Medical Association and © 2021 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.