CPT Code 20938: Structural autograft for spine surgery billing guide
CPT Code 20938 covers structural bicortical autograft through a separate incisio...
Last Updated: August 13, 2026
Key takeaways
HCPCS Code E0607 is the Medicare Part B billing code for a home blood glucose monitor supplied to a diabetic patient.
Coverage under LCD L33822 requires a documented diabetes diagnosis, an E10.x or E11.x code, and a treating practitioner’s order.
CMS stopped accepting Certificates of Medical Necessity in 2023, so the Standard Written Order now carries the order requirement.
Omitting the KX modifier, which attests that coverage criteria are met, is a leading cause of E0607 denials.
A4238 and A4239 are continuous glucose monitor supply allowance codes, not blood glucose monitor accessory codes.
HCPCS Code E0607 is the Medicare billing code for a home blood glucose monitor. It covers the finger-stick meter a diabetic patient uses to check capillary glucose at home. Claims go to a DME Medicare Administrative Contractor (MAC), not a Part A intermediary.
Coverage sits under Local Coverage Determination L33822. According to the Centers for Medicare & Medicaid Services (CMS), HCPCS Level II E-codes cover durable medical equipment (DME). E0607 is the specific code for the monitor itself.
This guide covers the 2026 fee schedule mechanics, the coverage criteria, and the documentation that has to be on file. It also covers the modifiers, the companion supply codes, and how E0607 differs from continuous glucose monitor (CGM) codes.
HCPCS Code E0607: Definition and code details
E0607 describes a home blood glucose monitor, the traditional finger-stick device used to measure capillary blood glucose. It falls within the E-code range of HCPCS Level II, which covers durable medical equipment.
The code is used by DMEPOS-accredited suppliers and by practices that supply monitoring equipment directly to patients. Pabau’s claims management software puts HCPCS code selection inside the patient workflow, so nobody retypes data from a code-lookup tool into a billing system.
2026 Medicare fee schedule for E0607
Medicare reimburses E0607 under the DMEPOS fee schedule, which CMS updates annually. Rates vary by MAC jurisdiction, and the purchase-versus-rental distinction applies to monitoring equipment.
For 2026 rates in your MAC region, use the CMS fee schedule lookup tool. The table below shows the rate structure. Verify the locality-adjusted figures in the current DMEPOS fee schedule download for your jurisdiction.
Suppliers in competitive bidding areas must confirm whether a DMEPOS contract covers E0607 in their region. Billing the standard fee schedule rate where a contract supplier rate applies is a common compliance risk.
Medicare coverage criteria under LCD L33822
Coverage under LCD L33822 is not automatic. The patient must meet specific clinical criteria, and the supplier must document each element before submitting a claim. One missing criterion is enough to trigger a denial.
LCD L33822, maintained by the DME MACs, governs coverage for glucose monitors including E0607. The core covered indications are:
- The patient has a confirmed diagnosis of diabetes mellitus, Type 1 or Type 2
- A treating practitioner has issued a written order for the home blood glucose monitor
- The record shows that monitoring is part of the patient’s diabetes management plan
- The patient or caregiver can operate the device and will use it as ordered
Non-covered situations include patients with no documented diabetes diagnosis. Coverage also fails where the record does not support home monitoring at the prescribed frequency. Pabau’s compliance management software keeps signed orders and clinical notes with the patient record, so the file stays audit-ready.
Coverage under the Part B DME benefit
E0607 is billed through the DME MAC, not the Part A intermediary. The supplier must hold active DMEPOS accreditation and be enrolled with the relevant DME MAC. Practices that supply the equipment themselves meet the same enrollment standards as standalone suppliers.
The same accreditation and proof-of-delivery rules cover the rest of a practice’s DME line, including items such as E0329 and E0248. One enrollment record, one set of order rules.
ICD-10 diagnosis codes that support medical necessity
Every E0607 claim needs at least one ICD-10-CM diagnosis code that establishes medical necessity. Per LCD L33822, supported diagnoses come from the E10 and E11 families, plus other specified and unspecified diabetes categories.
Report the most specific ICD-10-CM code the clinical record supports. Submitting E11.9 when the chart documents hypoglycemia with insulin use undercodes the claim, and it may not hold up in a post-payment audit. A documented plan for hypoglycemia risk, such as a hypoglycemia nursing care plan, gives the coder something specific to work from.
A tight medical forms workflow at the point of service captures those specifics before the claim goes out.
Pro Tip
Audit your last 20 E0607 claims. If most report only E11.9, with no secondary code such as Z79.4, your documentation process is losing detail. The chart usually holds that detail already. More specific diagnosis coding improves your audit standing and reduces medical necessity denials.
Documentation requirements for billing E0607
Inadequate documentation is the leading cause of post-payment recovery actions for DME claims. Per LCD L33822 and Policy Article A52464, the following must be in the file before the claim is submitted:
- Standard Written Order (SWO): the order must name the patient, the item, the quantity, the order date, and the treating practitioner who signed it. Verbal orders must be followed by an SWO before the claim is submitted.
- No Certificate of Medical Necessity: CMS discontinued CMN and DIF forms for dates of service from January 1, 2023. The SWO and the medical record now carry what those forms used to attest.
- Diabetes diagnosis in the medical record: the chart must document Type 1 or Type 2 diabetes mellitus with a covered ICD-10-CM code.
- Frequency documentation: the record must support the prescribed testing frequency. Billing supply quantities above the documented frequency is a common audit finding.
- Patient or caregiver training: a note showing that the patient or a designated caregiver was instructed on device use.
Pabau’s digital intake forms and patient record management keep the signed order, the chart note, and the ICD-10 linkage in one audit trail. That helps most when the same team runs the clinical visit and the DME supply.
Retention requirements
DME suppliers must retain documentation for at least seven years from the date of service. The DME MAC can request records during a pre-payment review, a Targeted Probe and Educate audit, or a Recovery Audit Contractor review. Disorganized records are treated the same as missing records. Structured HIPAA-compliant documentation protects the patient and the practice during those reviews.
Modifiers and claim submission rules
The modifier on an E0607 claim tells the DME MAC whether coverage criteria are met and where the supplier stands on compliance. Using the wrong modifier, or leaving it off, is one of the most direct paths to a denial.
The KX modifier carries compliance weight. Appending it attests that the file supports every LCD L33822 criterion. Suppliers who add KX by default, without the documentation behind it, are exposed under the False Claims Act. Solid EHR integration puts the documentation check and the modifier choice in the same process step.
ABN obligations
When a supplier expects Medicare to deny an E0607 claim, the Advance Beneficiary Notice must reach the patient before the device is dispensed. Miss that step and the supplier absorbs the full cost of a denial. The GA modifier tells Medicare the ABN was issued properly, so build the signature into your dispensing checklist.
Related HCPCS codes for glucose monitoring supplies
E0607 covers the monitor itself. The supplies needed to run the device are billed under separate companion codes, submitted on a recurring basis while the patient keeps monitoring.
Two codes are worth flagging because they look like blood glucose monitor supply codes and are not. A4238 and A4239 are monthly supply allowances for continuous glucose monitors, adjunctive and non-adjunctive in that order. Neither belongs on a claim for finger-stick supplies.
Quantity limits apply to A4253 and A4259. The testing frequency in the order sets the maximum billable quantity. Exceeding it is a high-frequency audit finding, as CMS notes in its compliance tips. Practices using prescription management software can align reorder quantities with the documented protocol automatically.
E0607 vs. continuous glucose monitor (CGM) codes
Most E0607 coding errors start here. Finger-stick monitors and CGM devices are different technologies with different coverage criteria and separate supply code chains. Mixing them up costs suppliers money and creates compliance exposure.
CGM criteria are the stricter half of L33822, and several MAC jurisdictions add a prior authorization step. A patient on basal insulin with no documented hypoglycemia unawareness usually qualifies for E0607 rather than a CGM. Billing E2103 for that patient, when only the E0607 criteria are met, is a false claims risk.
Confirm the descriptor before you submit. The AAPC HCPCS lookup carries current descriptions, and this code family changes more often than most coders expect.
Practices that manage diabetic patients across service lines feel this decision most. A metabolic health EMR keeps the clinician’s monitoring rationale on the record the biller works from. That shortens the trip from assessment to DME order.
The same holds in weight loss practices, where glucose monitoring often starts alongside GLP-1 therapy. The monitor is ordered at the first visit, so the coding decision lands before anyone has seen a trend.
Pro Tip
Review each CGM versus BGM billing decision against the treating physician’s most recent clinical note. The note should document the insulin regimen, the testing frequency, and the reason for the monitoring technology chosen. That note is your first line of defense in a MAC audit of code selection.
How practice management software keeps E0607 claims audit-ready
In most practices this process runs across three places. The signed order sits in the chart, the HCPCS code lives in a billing tool, and the diagnosis gets retyped at claim time. Every handoff is a chance for the claim and the file to disagree.
Practice management software like Pabau keeps all of it on one patient record. The standard written order, the ICD-10 code, the testing frequency, and the HCPCS selection sit on one timeline. A records request becomes an export rather than a hunt.
That changes when the checking happens. A biller can see the order date, the documented frequency, and the KX attestation before the claim goes out. Nobody reconstructs them after a denial.
Manage DME documentation and claim submissions in one place
Pabau connects written orders, ICD-10 documentation, and HCPCS code selection in one clinical workflow. Your team submits E0607 claims with the file already complete.
Conclusion
E0607 pays reliably when the file and the claim say the same thing. The order, the diagnosis code, the documented testing frequency, and the KX attestation all have to line up.
If you change one thing after reading this, make it the 2023 documentation shift. Any workflow still waiting on a signed CMN is holding claims for a form Medicare stopped accepting three years ago.
Move the order, the diagnosis, and the code selection onto one record and the denial pattern usually corrects itself. Book a demo to see how Pabau keeps DME orders, diagnosis coding, and claim documentation together.
Continue your research
Billing other DME supplies on a monthly cycle? A4771 walks through the frequency and documentation rules for a recurring supply code.
Supplying wheelchair parts alongside monitoring equipment? K0065 covers how replacement component claims are documented and priced.
Comparing claim submission tools? Pabau vs Waystar sets the two claims workflows side by side for practices that bill Medicare directly.
Tracking insulin and testing alongside glucose results? Medication log template gives you a printable record patients can keep between visits.
Reviewing a diabetic patient’s full medication list? Medication review template structures the review so hypoglycemia risk is documented in the chart.
Frequently asked questions
What is HCPCS Code E0607?
HCPCS Code E0607 is the Level II billing code for a home blood glucose monitor. It covers the finger-stick device a diabetic patient uses to measure capillary glucose at home. Claims go to a DME MAC under the Medicare Part B DME benefit, and coverage sits under LCD L33822.
Is E0607 a CPT code or an HCPCS code?
E0607 is an HCPCS Level II code, not a CPT code. HCPCS Level II codes start with a letter and cover supplies, equipment, and services that CPT does not address. CPT codes are five-digit numeric codes maintained by the AMA, and they mostly cover physician services and procedures.
What is the 2026 Medicare fee schedule rate for E0607?
The rate varies by MAC jurisdiction and locality. E0607 is paid as a one-time purchase under the inexpensive or routinely purchased (IRP) DME category. Medicare pays 80% after the Part B deductible. Check your locality figure in the current CMS DMEPOS fee schedule download.
What documentation is required to bill HCPCS Code E0607?
You need a Standard Written Order (SWO) from the treating practitioner naming the patient, the item, the quantity, and the order date. CMS discontinued Certificates of Medical Necessity for dates of service from January 1, 2023. The medical record must also show the diabetes diagnosis, the ordered testing frequency, and patient training. Keep the file for at least seven years.
How do E0607 and CGM codes differ?
E0607 covers a finger-stick blood glucose monitor. A non-adjunctive CGM is billed as E2103, which replaced the retired K0554 on January 1, 2023. Both sit under LCD L33822, but the CGM criteria are stricter and often require prior authorization. CGM supplies are billed with the monthly allowance codes A4239 or A4238.
What modifiers apply to HCPCS Code E0607 claims?
Append KX when every LCD L33822 criterion is met and the documentation is on file. Use GA when an ABN was issued because denial is likely. GY applies when the item is not a Medicare benefit. GZ applies when criteria are not met and no ABN was issued. Omitting KX is a leading cause of E0607 denials.
Can A4238 or A4239 be billed with E0607?
No. A4238 and A4239 are monthly supply allowance codes for continuous glucose monitors, adjunctive and non-adjunctive in that order. Finger-stick supplies are billed as A4253 strips, A4259 lancets, and A4233 through A4235 batteries.
