Healthcare Insights
Top 10 DME codes for diabetes patients
Healthcare providers use a durable medical equipment (DME) code to order specific medical equipment or supplies for a patient’s routine, long-term use. Types of durable medical equipment include wheelchairs, hospital beds, blood glucose monitors, and much more.
Using Definitive Healthcare’s Atlas All-Payer Claims data, we ranked the top 10 DME codes used by doctors to treat patients with diabetes. This data represents codes used to treat patients for the full year 2022.
| HCPCS/CPT code | Description | % of DME codes for diabetes patients | Explore dataset |
|---|---|---|---|
| K0553 | Supply Allowance For Therapeutic Continuous Glucose Monitor (Cgm) | 78.10% | Explore |
| K0554 | Receiver (Monitor), Dedicated, For Use With Therapeutic Glucose Continuous Monitor System | 5.90% | Explore |
| E0784 | External Ambulatory Infusion Pump, Insulin | 3.80% | Explore |
| E0607 | Home Blood Glucose Monitor | 1.70% | Explore |
| K0001 | Standard Wheelchair | 0.90% | Explore |
| K0552 | Supplies For External Non-Insulin Drug Infusion Pump, Syringe Type Cartridge, Sterile, Each | 0.60% | Explore |
| L5000 | Partial Foot, Shoe Insert With Longitudinal Arch, Toe Filler | 0.60% | Explore |
| L3000 | Foot, Insert, Removable, Molded To Patient Model, 'Ucb' Type, Berkeley Shell, Each | 0.40% | Explore |
| E0260 | Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress | 0.40% | Explore |
| K0195 | Elevating Leg Rests, Pair (For Use With Capped Rental Wheelchair Base) | 0.30% | Explore |
Fig. 1. Data is from Definitive Healthcare’s Atlas All-Payer Claims. The ranking is based on the number of claims filed for the full year 2022. Claims data is sourced from multiple medical claims clearinghouses in the United States and is updated monthly. Data accessed April 2023.
What is the most common DME code used for diabetes patients?
The most common DME code used for diabetes patients is “Supply Allowance for Therapeutic Continuous Glucose Monitor,” which accounts for 78.1% of all DME codes used in 2022 to treat diabetics.
Most diabetes patients use a continuous glucose monitor (CGM) to monitor their glucose levels and ensure that it doesn’t get too low or too high. Code K0553 specifically relates to the monthly supply allowance for these devices, including the CGM sensors, CGM transmitters, home blood glucose monitors, and supplies such as test strips, lancets, lancing devices, and calibrating solutions. Since most diabetics use one of these devices and need additional supplies throughout the year, it’s logical that this code tops the list.
The second most common DME code is “Receiver (Monitor), Dedicated, For Use with Therapeutic Glucose Continuous Monitor System,” which accounts for 5.9% of all codes for diabetic patients. This code is frequently used in conjunction with code K0553 but relates specifically to a therapeutic, non-adjunctive CGM device/receiver. This code is not used as frequently, which accounts for it taking up a lower share of the claims.
As of January 1, 2023, CMS retired both K0553 and K0554 and replaced them with codes A4239 (Supply allowance for adjunctive, non-implanted continuous glucose monitor, includes all supplies and accessories, 1 month supply = 1 unit of service) and E2103 (Adjunctive, non-implanted continuous glucose monitor or receiver).
The third most common DME code is “External Ambulatory Infusion Pump, Insulin,” which accounts for 3.8% of all DME codes for diabetic patients. This piece of equipment is a small, battery-powered, programmable device that is used to provide continuous subcutaneous insulin infusion to patients with diabetes. The device ensures that the level of insulin the patient receives is controlled and continuous throughout the day, similar to how the body would naturally release insulin. Insulin pumps can help diabetic patients better manage blood sugar levels and limit the number of shots they need, making them a popular tool for diabetic patients to leverage.
What is diabetes, and how is it treated?
Diabetes occurs when a patient’s body does not make enough insulin or uses its insulin ineffectively. The disease can be classified into two types:
- Type 1 diabetes is caused by an autoimmune condition that prevents the body from producing insulin.
- Type 2 is when a patient’s blood glucose is too high, leading to other complications. Type 2 diabetes accounts for 90-95% of patients with diabetes.
Despite the number of complications associated with the disease, diabetes is highly treatable, and many of those afflicted with it live healthy and normal lives. However, there is no cure for the disease.
Diabetes can be treated with pills, insulin, or other injected medicines. People with type 1 will always need insulin, while people with type 2 can often be treated with oral medicine but may eventually need insulin later in life.
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