MiniMed Paradigm REAL-Time Revel
System

Coverage and Reimbursement

Commonly Billed Codes

Medtronic Diabetes has developed this reimbursement guide to assist you in billing for your services related to the initiation and follow-up of patients who have been prescribed the MiniMed Paradigm® REAL-Time Revel System, consisting of the MiniMed Paradigm 523 or 723 Insulin Pump and REAL-Time Continuous Glucose Monitoring (CGM); the Guardian® REAL-Time System; or the iPro™ Professional CGM.

Medtronic provides this information for your convenience only. It is not intended as a recommendation regarding clinical practice. It is the responsibility of the provider to determine coverage and submit appropriate codes, modifiers, and charges for the services that were rendered. Please contact your local carrier or payor to verify coverage criteria and billing/coding guidelines.

Insulin Pump Therapy

ICD-9 Codes

Diagnosis codes are used by both physicians and hospitals to document the indication for the procedure or service performed.

The list below includes common ICD-9 diagnosis codes for Diabetes Mellitus.*

ICD-9 Description Fifth Digit
0 1 2 3
250.0 Diabetes mellitus without mention of complication type II or unspecified type, not stated as uncontrolled type I [juvenile type], not stated as uncontrolled type II or unspecified type, uncontrolled type I [juvenile type], uncontrolled
250.1 Diabetes with ketoacidosis
250.4 Diabetes with renal manifestations
250.5 Diabetes with ophthalmic manifestations
250.6 Diabetes with neurological manifestations
250.7 Diabetes with peripheral circulatory disorders
250.8 Diabetes with other specified manifestations
250.9 Diabetes with unspecified complication

* Excludes 250.2 and 250.3 series for diabetes with coma

HCPCS II Device Codes

These codes are used by the entity that purchased and supplied the medical device, DME, drug, or supply to the patient. For insulin pumps and Personal CGM, this is typically a DME Supplier.

Product Code Description
Infusion sets - Medicare weekly allowable code A4221 Supplies for maintenance of drug infusion catheter, per week (list drug separately)
Infusion Sets, needle A4230 Infusion set for external insulin pump, noneedle cannula type
Infusion Sets,non-needle A4231 Infusion set for external insulin pump, needle type
Pump reservoirs (also K0552) A4232 Syringe with needle for external insulin pump, sterile, 3 cc
Alcohol wipes A4245 Alcohol wipes, per box
Betadine swabs, per box A4247 Betadine or iodine swabs/wipes, per box
Adhesive, liquid, per ounce A4364 Adhesive, liquid or equal, any type, per oz.
Adhesive remover wipes, per 50 A4365 Adhesive remover wipes, any type, per 50
Tape A4450 Tape, nonwaterproof, per 18 sq in
Adhesive Remover A4455 Adhesive remover or solvent (for tape, cement or other adhesive), per oz.
Transparent Film, 16 sq. in or less A6257 Transparent film, sterile, 16 sq in or less, each dressing
Transparent Film, more than 16 sq. in A6258 Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing
Insulin Pump E0784 External ambulatory infusion pump, insulin
Pump reservoirs (also A4232) K0552 Supplies for external drug infusion pump, syringe type cartridge, sterile, each
Replacement battery, pump, silver oxide (MMT-104) K0601 Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each
Insulin* J1815 Injection, insulin, per 5 units
Insulin for insulin pump** J1817 Insulin for administration through DME (i.e., insulin pump) per 50 units

* For Medicare, use J1817.
** Only for insulin purchased under the DME benefit, such as for Medicare use.

CPT/HCPCS II Codes for Provider Services

Providers use CPT (and certain HCPCS II) codes for all services. Under Medicare’s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each code is assigned a point value, the relative value unit (RVU), which is then converted to a dollar payment amount. Many private payors use Medicare RVUs as the basis of their payment rates.

Service Code and Description Providers Who Can Perform the Service Payment Level*

Office visit to discuss insulin pump therapy initiation 

Follow-up visits to discuss therapy modifications, etc.

Evaluation and Management (E/M) Codes:

99211 Office or other outpatient visit (only E/M code can be performed by a non-physician or mid-level practitioner)

99212-99215 Office or other outpatient visit

99354-99355 Proglonged service, office (must be billed with 99212-99215)

MD/DO
NP/PA
99211-99215
Medicare: $19-$125
Medicare RVU: 0.52-3.46
 

99354-99355
Medicare: $92-$91
Medicare RVU: 2.55-2.52

Medical management to start patients on insulin pump therapy (CSII) as it relates to insulin: carb ratios, basal rates, sick day management, insulin sensitivity for correction factor, etc.

Diabetes Self Management Education and Training (DSMT) Codes:

G0108 Diabetes outpatient self-management training services, individual, per 30 minutes

G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

Or

98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient

98961 ;2-4 patients

98962 ;5-8 patients

CDEs/RDs/RNs in ADA-recognized programs G0108-G0109
Medicare: $23-$13
Medicare RVU: 0.64-0.36

98960-98962
Medicare: $24-$9
Medicare RVU: 0.66-0.24


Medicare does not pay for 98960-98962, but does publish RVUs for these codes

* Medicare 2009 national average allowable amount, rounded to the nearest full dollar amount. Includes 20% patient copayment amount. All RVUs are for services performed in the physician's office.
Source: Medicare Physician Fee Schedule 2009.

Personal CGM

ICD-9 Codes

Diagnosis codes are used by both physicians and hospitals to document the indication for the procedure or service performed.

The list below includes common ICD-9 diagnosis codes for Diabetes Mellitus.*

ICD-9 Description Fifth Digit
0 1 2 3
250.0 Diabetes mellitus without mention of complication type II or unspecified type, not stated as uncontrolled type I [juvenile type], not stated as uncontrolled type II or unspecified type, uncontrolled type I [juvenile type], uncontrolled
250.1 Diabetes with ketoacidosis
250.4 Diabetes with renal manifestations
250.5 Diabetes with ophthalmic manifestations
250.6 Diabetes with neurological manifestations
250.7 Diabetes with peripheral circulatory disorders
250.8 Diabetes with other specified manifestations
250.9 Diabetes with unspecified complication

* Excludes 250.2 and 250.3 series for diabetes with coma

HCPCS II Device Codes

These codes are used by the entity that purchased and supplied the medical device, DME, drug, or supply to the patient. For insulin pumps and Personal CGM, this is typically a DME Supplier.

Product Code Description
Alcohol wipes A4245 Alcohol wipes, per box
Betadine swabs, per box A4247 Betadine or iodine swabs/wipes, per box
Adhesive, liquid, per ounce A4364 Adhesive, liquid or equal, any type, per oz.
Adhesive remover wipes, per 50 A4365 Adhesive remover wipes, any type, per 50
Tape A4450 Tape, nonwaterproof, per 18 sq in
Adhesive Remover A4455 Adhesive remover or solvent (for tape, cement or other adhesive), per oz.
Transparent Film, 16 sq. in or less A6257 Transparent film, sterile, 16 sq in or less, each dressing
Transparent Film, more than 16 sq. in A6258 Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing
Sensors (per diem) A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, 1 unit = 1 day supply
CGM Transmitter A9277 Transmitter; external, for use with interstitial continuous glucose monitoring system
CGM Receiver (Guardian® System only) A9278 Receiver (monitor); external, for use with interstitial continuous glucose monitoring system

 

CPT/HCPCS II Codes for Provider Services

Providers use CPT (and certain HCPCS II) codes for all services. Under Medicare’s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each code is assigned a point value, the relative value unit (RVU), which is then converted to a dollar payment amount. Many private payors use Medicare RVUs as the basis of their payment rates.

Service Code and Description Providers Who Can Perform the Service Payment Level*

Initial CGM training, hookup, and download

95250** Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous  sensor for a minimum of 72 hours; sensor placement, hook-up calibration of monitor, patient training, removal of sensor, and printout of recording.

Qualified health care providers, consistent with state scope of practice laws

Medicare RVUs: 3.56

Medicare does not cover Personal CGM, but does publish RVUs for these codes.
Interpretation of CGM data

95251 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous  sensor for a minimum of 72 hours; interpretation and report.

MD/DO
NP/PA

Medicare RVUs: 1.10

Medicare does not cover Personal CGM, but does publish RVUs for these codes

Pre-/post-CGM evaluation

Evaluation and Management (E/M) Codes: ***

99212-99215 Office or other outpatient visit

99354-99355 Prolonged service, office (must be billed with 99212-99215)

MD/DO
NP/PA

99212-99215
Medicare: $37-$125
Medicare RVU: 1.03-3.46

99354-99355
Medicare: $92-$91
Medicare RVU: 2.55-2.52

Source: Medicare Physician Fee Schedule 2009.
* Medicare 2009 national average allowable amount, rounded to the nearest full dollar amount. Includes 20% patient copayment amount. All RVUs are for services performed in the physician’s office.
** Use the reduced service modifier (-52) if the patient owns the equipment (therefore not an expense to the provider).
*** An office visit can only be billed separately when a CGM service is provided to the same patient on the same day if a full-scale, separately identifiable evaluation and management service takes place in addition to the CGM service. In this circumstance, the modifier -25 should be billed with the E/M code to indicate that a separate and distinct E/M service was provided.

For questions, email rs.nradvance@medtronic.com with the subject line: Billing & Coding Questions

Last updated: 24 Jan 2012

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