Implantable CGMs have distinct coding practices

Implantable Continuous Glucose Monitoring (CGM) systems have transformed diabetes management, offering patients a more convenient and less intrusive option compared to traditional CGMs. For individuals managing diabetes, the appeal of implantable CGMs lies in their longevity and lower maintenance, eliminating the need for frequent sensor changes and providing continuous, consistent glucose monitoring for up to six months. This advancement may enhance the patient's quality of life as it streamlines the daily diabetes management routine.

Implantable CGMs bring a significant shift in diabetes care and coding practices. Classified under Medicare Part B, unlike traditional CGMs, these devices have their own codes in billing and reimbursement strategies distinct from traditional CGMs. Health care providers must navigate this change with a comprehensive understanding of the unique billing codes specific to the implantation and maintenance of these devices.

• 0446T: This code is used for the initial insertion of the implantable glucose sensor.
• 0447T: This code applies to the removal of the implantable glucose sensor.
• 0448T: This code represents the combined procedure of removing and reinserting the implantable glucose sensor.

The integration of implantable CGM systems into clinical practice is a significant step forward for health care providers. Accurate application of the codes 0446T, 0447T and 0448T is crucial for appropriate Medicare billing and reimbursement. Familiarity with these codes ensures that services related to implantable CGMs are correctly documented and billed, facilitating patient access to this innovative technology.

CPT Code 95251 is used for the interpretation and report of the CGM data, which includes a minimum of 72 hours of data collection. Here, there is the need for a written report, which should be detailed and include trend analysis that provides actionable insights for patient management. It emphasizes the clinical value of CGM data beyond data collection, focusing on interpretation that guides therapeutic decision-making.

Recent Changes in Medicare Reimbursement
as of December 2023  

Medicare Coverage

Shifts to Medicare Part B from DME (Durable Medical Equipment) coverage, affecting billing practices. 

Coding Changes

Specific CPT codes for implantable devices have been introduced, which are different from non-implantable CGM systems. 

Coverage Policies

Efforts are ongoing to standardize coverage policies across Medicare Part B MACs, with expectations for changes by Q1 of 2024. 

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