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A NEW WAY TO PROCESS, DISTRIBUTE AND SERVICE MEMBERS

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Simplified claims processing

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HCP-governed CGM administration

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Improved member experience

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ICD-10 coding and billing

Eversense is indicated for adults with insulin-dependent diabetes, using all applicable ICD-10-CM codes based on the complexity of the diagnosis.

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Category III CPT codes

Three specific Category III CPT codes are required to report the implantation and/or removal of the Eversense Sensor. Please note some other payers may not cover these codes, making prior authorization necessary. These codes are:

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0446T

 

Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training. (Do not report 0446T in conjunction with 95251, 0447T, 0448T).

 

0447T

 

Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision.

 

0448T

 

Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and implantation insertion of new implantable sensor, including system activation.
(Do not report 0448T in conjunction with 0446T, 0447T).

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Category I CPT code for CGM analysis and interpretation

Providers may also represent their analysis and interpretation of Eversense data using:

 
 

CPT 95251

 

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

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CPT Code Official Description
Estimated Commercial Payments
 
Medicare Physician Payments Medicare HOPD Payments
0446T Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training $174.964,5 Carrier Priced $483.15
0447T Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision $195.704,5 Carrier Priced $175.38
0448T Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation $282.534,5 Carrier Priced $483.15
95251 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report $44.064,5 $36.72 N/A (professional service not paid in HOPD)

 

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CPT Code

0446T

Official Description

Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training

Estimated Commercial Payments

$174.96 4,5

Medicare Physician Payments

Carrier Priced

Medicare HOPD Payments

$483.15

0447T

Official Description

Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation

Estimated Commercial Payments

$195.70 4,5

Medicare Physician Payments

Carrier Priced

Medicare HOPD Payments

$175.38

0448T

Official Description

Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation

Estimated Commercial Payments

$282.53 4,5

Medicare Physician Payments

Carrier Priced

Medicare HOPD Payments

$483.15

95251

Official Description

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

Estimated Commercial Payments

$44.06 4,5

Medicare Physician Payments

$36.72

Medicare HOPD Payments

N/A (professional service not paid in HOPD)
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Crosswalk codes for billing physician service time

Since Eversense Category III CPT are not associated with RVUs, the best practice for establishing payments is to provide a “crosswalk” to a similar procedure, such as the existing Level II HCPCS codes for traditional CGM systems supplied through the DME benefit.

 
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Category III codes approved for publication in 2017
CODE DESCRIPTION
0446T Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training
0447T Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision
0448T Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation

 

Non-biodegradable drug delivery implant
CODE DESCRIPTION TOTAL RVU PAYMENT
11981 Insertion, non-biodegradable drug delivery implant 4.01 $145.80
11982 Removal, non-biodegradable drug delivery implant 4.55 $163.08
11983 Removal, with reinsertion, non-biodegradable drug delivery implant 6.41 $235.44
 

 

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Category III codes approved for publication in 2017

0446T

Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training

0447T

Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision

0448T

Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation
Non-biodegradable drug delivery implant

11981

Description

Insertion, non-biodegradable drug delivery implant

TOTAL RVU

4.01

Payment

$145.80

11982

Description

Removal, non-biodegradable drug delivery implant

TOTAL RVU

4.55

Payment

$163.08

11983

Description

Removal, with reinsertion, non-biodegradable drug delivery implant

TOTAL RVU

6.41

Payment

$235.44
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