# Eversense



## NESSAM100@GMAIL.COM (Jan 8, 2019)

We are starting a new procedure in endocrinology _ Which is an under the skin Senor Placement to monitor CGM - How would I go about coding this  when  being told to code a office visit  (99215-99215) w/ modifier 25 and code 0446T , The problem I am having is the DME Company already billed the Insurance for delivery of this product to our office using this code. and the place is under the skin which would be an AMBULATORY procedure since we have to cut the skin to implant and remove  product. Also would you use the regular CGM CODES OF 95250 OR 95251 TO REMOVE.  


Please advise as to how to bill this.


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## Jbeck@karuk.us (May 28, 2019)

95250 is the placement, calibration, patient training, downloading of at least 72 hours of data, printout of data recording, and removal of a sensor owned by the medical practice.  My understanding is that all elements must be performed in order to bill this code, so the date billed should be the date of download/removal.
(CORRECTION/EDIT: I have been told that the date of service for the 95250 needs to be different from the date of interp, so have been instructed to use the date of placement for code 95020.)
95251 is for the physician's interp & report on the data downloaded. This should be documented in the patient's chart, and billed for the date that physician did the interpretation.
You can only bill a separate E&M code when the physician documents separately identifiable services, as when changes in treatment plan are made based on the interpreted report.  25 modifier is needed for same-date billing.

Can ANYONE confirm whether or not 95250 can be billed if all the elements are not met??  As in, if pt knocks the sensor off and only 60 hours of data is retrievable, or if patient never returns sensor at all??


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## Jdelrosario1@comcast.net (Aug 6, 2019)

you would still use the 0446T, 0047T, and 0448T for the insertion, removal, or removal and reinsertion. It doesn't matter what the company bill for the product. You would not use the 95250 for this for 2 reasons- the patient owns the equipment since his insurance was billed for the product, so if this was appropriate you would use 95249, not 95250. You only use 95250 when the office owns the equipment- but neither is appropriate for eversense.  Eversense is its own type of CGM considered "implantable", and if you look, most major insurance carriers specifically name, eversense, and consider it investigational and non covered.  95250/95249 can only be billed when all elements are met.  But their sensor coming out will only effect the interpretation.  95251 can only be billed if there is at least 72 hours of data, and should be billed on the date it was interpreted.  Example: in my office. we bill the 95249/95250. If their sensor comes off early- they come in and we reattach it as a no charge visit (because you cannot charge 95249/95250 again),  but you cannot bill the 95251 until you have at least 72 hours worth of date to interpret, and can typically only be billed ever 30 days.


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