JillMedicalBiller
Contributor
Hello!
So, when issuing an ABN to a Medicare patient for a service/supply that Medicare normally covers, like glucose test strips, but now Medicare won't cover it because the patient has a CGM; is it appropriate to bill the patient the normal "Allowed Amount" that Medicare imposes, or can you bill the patient the provider office "Charged Amount"?
Is it even appropriate to issue and ABN to a CGM patient for test strips when the supply allowance for an E2103 CGM supply allowance code A4239 states that: "The supply allowance for supplies used with a CGM system (A4238, A4239) encompasses all items necessary for the use of the device and includes but is not limited to, CGM sensors and transmitters. For non-adjunctive CGMs, the supply allowance (A4239) also includes a home BGM and related supplies (test strips, lancets, lancing device, calibration solution, and batteries), if necessary. Supplies or accessories billed separately will be denied as unbundling." -Glucose Monitor - Policy Article A52464
Does the provider's office need to view the test strips as bundled with the CGM supply allowance and therefore, write it off, or can an ABN be issued, since the E2103 non-adjunctive CGM replaces the Home BGM?
Thank you in advance for any input on these issues!
So, when issuing an ABN to a Medicare patient for a service/supply that Medicare normally covers, like glucose test strips, but now Medicare won't cover it because the patient has a CGM; is it appropriate to bill the patient the normal "Allowed Amount" that Medicare imposes, or can you bill the patient the provider office "Charged Amount"?
Is it even appropriate to issue and ABN to a CGM patient for test strips when the supply allowance for an E2103 CGM supply allowance code A4239 states that: "The supply allowance for supplies used with a CGM system (A4238, A4239) encompasses all items necessary for the use of the device and includes but is not limited to, CGM sensors and transmitters. For non-adjunctive CGMs, the supply allowance (A4239) also includes a home BGM and related supplies (test strips, lancets, lancing device, calibration solution, and batteries), if necessary. Supplies or accessories billed separately will be denied as unbundling." -Glucose Monitor - Policy Article A52464
Does the provider's office need to view the test strips as bundled with the CGM supply allowance and therefore, write it off, or can an ABN be issued, since the E2103 non-adjunctive CGM replaces the Home BGM?
Thank you in advance for any input on these issues!