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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:
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).
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.
| 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) |
CPT Code
0446T
Official Description
Estimated Commercial Payments
Medicare Physician Payments
Medicare HOPD Payments
0447T
Official Description
Estimated Commercial Payments
Medicare Physician Payments
Medicare HOPD Payments
0448T
Official Description
Estimated Commercial Payments
Medicare Physician Payments
Medicare HOPD Payments
95251
Official Description
Estimated Commercial Payments
Medicare Physician Payments
Medicare HOPD Payments
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.
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 |