How To Use HCPCS Code A4239

HCPCS code A4239 describes the supply allowance for a non-adjunctive, non-implanted continuous glucose monitor (CGM), including all supplies and accessories. This code is used to identify the one-month supply of these CGM supplies. In this article, we will explore the details of HCPCS code A4239, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A4239?

HCPCS code A4239 is used to identify the supply allowance for a non-adjunctive, non-implanted continuous glucose monitor (CGM), including all supplies and accessories. This code represents a one-month supply of these CGM supplies. It is important to note that this code specifically applies to non-adjunctive and non-implanted CGMs.

2. Official Description

The official description of HCPCS code A4239 is “Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service.” The short description for this code is “Non-adj cgm supply allow.”

3. Procedure

1. When providing the supply allowance for a non-adjunctive, non-implanted continuous glucose monitor (CGM), the healthcare provider should ensure that all necessary supplies and accessories are included.
2. The supply allowance should cover a one-month period, as indicated by the unit of service.
3. It is important to accurately document and track the usage of these CGM supplies to ensure appropriate billing and reimbursement.

4. When to use HCPCS code A4239

HCPCS code A4239 should be used when providing a one-month supply of non-adjunctive, non-implanted continuous glucose monitor (CGM) supplies. It is important to ensure that the CGM being supplied meets the criteria of being non-adjunctive and non-implanted. This code should not be used for other types of CGMs or for supplies that cover a different duration.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A4239, healthcare providers should ensure that the following guidelines and documentation requirements are met:

• Accurately document the provision of the non-adjunctive, non-implanted continuous glucose monitor (CGM) supplies.
• Include all necessary supplies and accessories in the supply allowance.
• Ensure that the supply allowance covers a one-month period.
• Submit the appropriate claim form with the correct HCPCS code and supporting documentation.

6. Historical Information and Code Maintenance

HCPCS code A4239 was added to the Healthcare Common Procedure Coding System on January 01, 2023. As of its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A4239 may vary. It is important to check with the specific payer for their coverage policies and guidelines. The pricing indicator code for this code is 34, which indicates that it falls under DME supplies and is subject to pricing floors and ceilings. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code A4239 should be billed:

1. A patient with diabetes requires a non-adjunctive, non-implanted continuous glucose monitor (CGM) and the healthcare provider supplies them with a one-month worth of CGM supplies and accessories.
2. A healthcare facility provides a non-adjunctive, non-implanted continuous glucose monitor (CGM) to a patient for home use and includes a one-month supply of CGM supplies and accessories.
3. A physician prescribes a non-adjunctive, non-implanted continuous glucose monitor (CGM) to a patient and the healthcare provider dispenses a one-month supply of CGM supplies and accessories.
4. A patient’s non-adjunctive, non-implanted continuous glucose monitor (CGM) malfunctions and the healthcare provider replaces it with a new CGM along with a one-month supply of CGM supplies and accessories.
5. A patient’s non-adjunctive, non-implanted continuous glucose monitor (CGM) is lost and the healthcare provider provides a replacement CGM along with a one-month supply of CGM supplies and accessories.