HCPCS Code A9278: Receiver; External, for Use DME Interstitial Continuous Glucose Monitoring System

## **A9278 documentation requirements** Clear documentation is essential for establishing the medical necessity of CGM devices and ensuring claims pass audit review. ### **Patient eligibility and indication** Record that the patient has a diagnosis of diabetes mellitus and requires continuous glucose monitoring. Include details on insulin use, hypoglycemia risk, or other criteria that meet payer coverage policies. ### **Device description** Identify the CGM system prescribed and note that the receiver (external monitor) is being provided. Specify that this is a non-durable medical equipment item, distinct from durable receivers billed under different codes. ### **Prescription** A dated prescription from the treating practitioner must be present in the record. It should indicate that the patient or caregiver has received, or will receive, sufficient training to use the CGM receiver safely and effectively. ### **Training** Document that the patient or caregiver was trained in how to operate the device and demonstrated the ability to use it correctly. This may include setting alerts, checking glucose trends, and performing receiver maintenance.

## **A9278 billing requirements** Billing for A9278 depends on payer rules. Effective April 1, 2022, A9278 is no longer eligible for Medicare reimbursement. ### **Commercial insurance** Some commercial health plans reimburse A9278 when the CGM system is covered. Verify prior authorization requirements, frequency limitations, and whether coverage extends only to specific FDA-approved systems. ### **Bundling and replacement rules** Certain payers may bundle the cost of the receiver into the overall CGM system package. Others allow replacement receivers to be billed under A9278, but often limit frequency (for example, once every 1–2 years). ### **Coordination with other CGM components** Reference other related HCPCS codes if the transmitter or sensors are also being supplied. Ensure the medical record links the receiver to the prescribed CGM system.

## **Alternative codes to A9278** Some payers do not reimburse A9278, especially under Medicare, which classifies it as non-covered. In these cases, you may need to use a replacement code that better reflects the type of CGM system or supply being billed. E2103 is reported for a non-adjunctive, non-implanted continuous glucose monitor or receiver and is widely recognized by Medicare and many commercial payers as the covered alternative to A9278. Other codes sometimes used in place of A9278 include: - **E2102**: Adjunctive CGM receiver integrated with an insulin pump. - **A4239**: Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service Always check payer rules to determine which code applies, since coverage depends on whether the CGM is adjunctive or non-adjunctive and whether supplies are billed separately or bundled.

## **Other relevant codes** Here are some codes commonly reported with A9278 when documenting a complete CGM system: - **A9276**: Sensor; invasive (e.g., subcutaneous), disposable, for use with a non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply - **A9277**: Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system