Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge
Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
DME supplier: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Medicare pricing for E2104
DMEPOS fee schedule, July 2026 (DME26-C)
NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $54.52 in the contiguous states; $54.52 in AK, HI, PR and VI; ceiling $54.52, floor $46.34
RR (rental), inexpensive or routinely purchased (IN): non-rural $5.47 in the contiguous states; $5.47 in AK, HI, PR and VI; ceiling $5.47, floor $4.65
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $40.92 in the contiguous states; $40.92 in AK, HI, PR and VI; ceiling $40.92, floor $34.78
Payer policies and prior authorization for E2104
Payer coverage policies that name E2104
E2104 appears in 3 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.