A while back, DME MAC Noridian Healthcare Solutions, Inc. incorrectly rejected certain continuous glucose monitor (CGM) claims billed to Medicare Jurisdictions A and D between January 4 and January 19, 2023. The processing error rejected items billed with the old K0553 and K0554 HCPCS codes, but without a KF modifier. The reason given: invalid modifiers.

Claims billed without the KF modifier signal the billed item is a Class III device, but not all CGMs are Class III devices. Therein lies the error.

Next Episode: Thursday, August 22, 2024

Noridian addressed the claims processing logic error, but unlike other CGM processing issues earlier this year, Noridian is requiring suppliers to resubmit affected claims for proper adjudication.

As you may recall, Medicare replaced the non-adjunctive CGM HCPCS K0553 and K0554 codes on January 1 of this year with A4239 and E2103, respectively. Thus, claims affected by this error have service dates on or before December 31, 2022.

To help the billing department identify any unresolved claims that require resubmission, initiate a quick query for:

  • K0553 and K0554 claims,
  • Billed without the KF modifier,
  • Billed with service dates prior to December 31, 2022, and
  • Processed in January 2023.