Billing for Wearable Continuous Glucose Monitors 

Deciphering CPT Codes for Wearable Continuous Glucose Monitors

Diabetes care is constantly evolving with technological advancements like Continuous Glucose Monitors (CGM) and insulin pumps leading the charge. However, for health care providers, navigating the maze of reimbursement coding for these devices can be as challenging as managing the condition.

CPT codes 95250, 95251 and 95249 appear to be very similar and can easily be misused, but a closer look helps break down the nuances between each so you know the right code to use when billing.

A Closer Look at CPT Codes

CPT Code 95250: Professional Use CGM

This code covers the initial setup, patient education, hook-up, calibration of the monitor, removal of the device and printout of the recording of a professional use CGM.

It's also important to note that this code is billable only once per device insertion and doesn’t require a face-to-face interaction with the patient. This flexibility allows for broader application, especially in settings where remote patient monitoring is used.

CPT Code 95251: CGM Analysis & Interpretation

This code is used for the interpretation and report of the CGM data, which includes a minimum of 72 hours of data collection. Here, there is the need for a written report, which should be detailed and include trend analysis that provides actionable insights for patient management. It emphasizes the clinical value of CGM data beyond data collection, focusing on interpretation that guides therapeutic decision-making.

CPT Code 95249: Personal Use CGM

This code is specifically related to personal CGM systems and addresses the services associated with the setup and patient education on using the device. Unlike 95250, this code is more focused on the personal, at-home CGMs and involves direct patient education regarding the device's use and should not be used for a device that has been provided to a patient.

Knowing how to effectively use each of CPT codes 95250, 95251 and 95249 is fundamental for streamlined billing in diabetes technology management. By distinguishing between the setup, education and data interpretation associated with CGM devices, health care professionals can ensure accurate reimbursement. Staying updated with these coding practices reflects a commitment to quality care and operational efficiency in the dynamic field of diabetes treatment.

• CPT code 95250 is used when patients are set up with a device they don't own by a covered health care provider.  Reimbursement is approximately $140. 

Personal CGMs

• CPT codes include 95251 for analysis and interpretation.  

• 95249 for patient education on personal use CGMs.  

• Restrictions include billing once per month and the necessity for data to be downloaded at the office. 

• Revise existing code K0553, “Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service” to read: A4239, “Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service” 

• Revise existing code K0554, “Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system” to read:  E2103, “Non-adjunctive, non-implanted continuous glucose monitor or receiver” 

• Revise A4238, “Supply allowance for adjunctive continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service” to read:  A4238, “Supply allowance for adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service”  

• Revise E2102, “Adjunctive continuous glucose monitor or receiver” to read: E2102, “Adjunctive, non-implanted continuous glucose monitor or receiver” 

For more information on CGMs, visit Find & Compare CGMs