AACE GUIDE TO CONTINUOUS GLUCOSE MONITORING (CGM)

95249

Personal CGM Start-up and Training Ambulatory CGM of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording

RN, PharmD/RPh, RD, CDE, or MA (if within their scope of practice) and billed by the supervising physician, advanced practitioner, or hospital outpatient department

Once for the lifetime of the personal CGM device

Face-to-face visit

95250

Professional CGM Ambulatory CGM of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording

RN, PharmD/RPh, RD, CDE, or MA (if within their scope of practice) and billed by the supervising physician, advanced practitioner, or hospital outpatient department

Maximum of once per month

Face-to-face visit

95251

CGM Interpretation Ambulatory CGM of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report

Physician (MD, DO), NP, PA, or clinical nurse specialist

Maximum of once per month

Not required to have a face-to-face visit

–25 modifier

Evaluation and Management (Separate Identifiable Service) An E/M CPT code can be billed on the same day as codes 95249, 95250, and/or 95251 if documentation supports the medical necessity of a significant and separately identifiable evaluation and management service performed the same date. Modifier 25 is added to the E/M code to report a significant and separately identifiable evaluation and management performed above the CGM services.

Physician (MD, DO), NP, PA, or clinical nurse specialist

With office visits

Face-to-face visit