Provider Reminder: Type of Bill 13X – Correct Billing of CPT Code 82962
Recent Comprehensive Error Rate Testing (CERT) analysis has shown an increase in inappropriate billing by type of bill 13X for Current Procedural Terminology (CPT) 82962 (Glucose, blood by glucose monitoring device(s), cleared by the FDA specifically for home use).
CERT identified provider documentation errors for claims billed with CPT code 82962. Providers submitted documentation that supported routine testing and sliding scale insulin, per protocol, with no changes made or problems reported.
In order for glucose monitoring to be considered reasonable and necessary, it must be ordered by the physician who must be promptly notified of the results. The physician must use the results and instruct continuation or modification of patient care. This includes the physician’s order for another lab service. Appropriate documentation must be maintained to support the medical necessity of the service and the claim submitted.
Upon request by the CERT Documentation Contractor, it is important that providers submit adequate documentation for laboratory testing.
Educational articles providing the results of previous reviews and guidelines for the appropriate utilization of blood glucose monitoring were posted on What’s New from Cahaba GBA Web pages on December 15, 2005, February 8, 2007, May 2, 2007, July 25, 2007, October 24, 2007, March 3, 2008 and May 21, 2008.
For additional information regarding requirements for diagnostic tests, refer to the following references:
- Publication
100-02 Medicare Benefit Policy Manual - Change Request 5743; Transmittal
80 - Subject: Requirements for Ordering and Following Orders for
Diagnostic Tests
- CERT Report Data may be viewed by selecting the “CERT Reports” link
on the CMS
CERT Web page.
Page last updated: August 20, 2008
