TABLE 4

Coding for continuous glucose monitoring

CPT codeDescriptionComments
95249Personal (patient-owned) CGM: sensor placement, hook-up, calibration, patient training, and printoutOne-time code for initial start-up and education
95250Professional CGM (office-owned CGM), sensor placement, hook-up, calibration, patient training, removal of sensor, and printoutBilling code covers the cost of sensors and placement by clinician/staff
95251CGM data analysis and interpretation with report by clinicianCan be billed no more frequently than every 30 days
Coding guidelines
72 hours of data are required for billing any of these codes.
-25 modifier for CGM codes can be used if billing for CGM interpretation on the same day as a Problem Visit code (99212-99215).
If a significant and separately identifiable service took place:

  • 99212-99215: Pre-CGM evaluation (+) -25 95249: CGM start-up and instruction

  • 99212-99215: E and M code for problem visit (+) -25 95251: CGM analysis, interpretation, and report.

  • CGM = continuous glucose monitoring; CPT = current procedural terminology