CGM Billing Services
Continuous glucose monitor billing for DME suppliers, from the first device claim through every 90-day supply allowance after it.
- Coverage and visit documentation review
- Six-month follow-up visit tracking
- Device and supply allowance coding
- Denial work and appeals
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HIPAA compliant. We never share your data.
Why suppliers hand us their CGM billing
- 99.9% accuracy on the claims we work
- 97% collection rate
- We work inside Brightree, Bonafide, NikoHealth or TIMS
- HIPAA compliant handling of patient data
- ISO 9001 and ISO 27001 certified
- Medicare and plan-specific CGM rules kept apart in your setup
Getting the first CGM claim right
Under the Medicare Glucose Monitors LCD (L33822), a patient qualifies for a CGM when five things line up. They have diabetes. Their treating practitioner has prescribed the CGM, which shows the patient or caregiver is trained to use it. The device is prescribed in line with its FDA indications. The patient is either insulin-treated or has a documented history of problematic hypoglycemia. And within the six months before the order, the practitioner saw the patient in person or through a Medicare-approved telehealth visit and confirmed the first four points.
Problematic hypoglycemia has a specific meaning. It is either more than one level 2 event (glucose below 54 mg/dL) that continues despite more than one change to treatment, or one level 3 event where the patient needed help from another person. We check that the chart says so in plain terms before the device ships.
Keeping coverage after the first claim
CGM coverage is not a one-time approval. Every six months after the first prescription, the treating practitioner has to see the patient, in person or by Medicare-approved telehealth. The note must show the patient is sticking with the CGM regimen and their diabetes treatment plan. If that visit doesn’t happen, the device and supply claims that follow can be denied.
Supplies are billed as a monthly allowance, but you can bill no more than three units in 90 days, and you can’t send more than a 90-day supply at once. The usual refill contact rules do not apply to the CGM supply allowance codes.
We track the six-month visit date for every CGM patient and flag it before it lapses, so your team can nudge the practice instead of finding the gap in a denial.
HCPCS codes we bill
| HCPCS | Description |
|---|---|
| E2102 | Adjunctive, non-implanted continuous glucose monitor or receiver |
| E2103 | Non-adjunctive, non-implanted continuous glucose monitor or receiver |
| A4238 | Supply allowance for adjunctive, non-implanted CGM, includes all supplies and accessories (up to 3 units per 90 days) |
| A4239 | Supply allowance for non-adjunctive, non-implanted CGM, includes all supplies and accessories (up to 3 units per 90 days) |
Billing systems we work in
We log in to the system you already use. No migration, no new software for your team.
How we run your CGM billing
Before the claim
- Intake review: we check the diagnosis, the insulin or hypoglycemia documentation, the qualifying visit date and the standard written order.
- Product check: we confirm the CGM is listed on the PDAC Product Classification List under the code you plan to bill.
- Pairing check: we make sure the device code and the supply allowance code match (E2102 with A4238, E2103 with A4239).
After the claim
- Supply billing: allowances go out at no more than three units per 90 days, with delivery records that line up.
- Visit tracking: the six-month follow-up visit is tracked for every active patient.
- Denial follow-up: we work denials by root cause and feed what we learn back into intake.
Your patient data stays protected
We handle patient records under HIPAA and an ISO 27001 certified information security program. We work in your own billing system, so your data stays where it already lives.
What changes when we take over
- Fewer lapsed patients. Six-month visit dates are watched, not guessed.
- No new software. We work in Brightree, Bonafide, NikoHealth or TIMS.
- One team. One team for diabetes supplies and the rest of your DME billing services.
See how one supplier reduced denials and improved first-pass acceptance.
Frequently asked questions
Does a patient have to be on insulin to qualify for a CGM under Medicare?
No. Patients qualify if they are insulin-treated or if they have a documented history of problematic hypoglycemia, along with the other criteria in LCD L33822.
How often does the patient need to see their practitioner?
Once within the six months before the CGM is ordered, then every six months after that to document they are following the CGM regimen and treatment plan. Medicare-approved telehealth visits count.
How many CGM supply allowance units can be billed at once?
Up to three units of A4238 or A4239 per 90 days, and no more than a 90-day supply can be dispensed at a time.
Can we bill a blood glucose monitor along with a CGM?
With an adjunctive CGM (E2102), yes, a BGM and its supplies can be billed separately. With a non-adjunctive CGM (E2103), the CGM replaces the BGM, so those claims will be denied.