CPT Codes 95249, 95250, and 95251

Overview and FAQs

CPT® Codes 95249, 95250, and 95251

What codes are used to report continuous glucose monitors?

  • 95249 - 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.
  • 95250 - 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.
  • 95251 - Ambulatory CGM of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report.

Is it appropriate to report evaluation and management (E/M) codes when codes 95249/95250/95251 are being reported as well?

  • An E/M CPT code (99201-99205, 99211-99215, 99241-99245) may be reported with CPT® codes 95249, 99250 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. Check with your commercial payers to verify if modifier 25 is required when a separate and significant evaluation and management (E/M) service is performed on the same date of service as the 95249/95250/95251 is reported. *Physicians cannot count the interpretation and report of the CGM data in their Medical Decision-Making portion of the E/M if reporting CPT® code 95251 on the same date as an E/M service.

Who can provide the professional interpretation of a CGM?

  • A physician (MD, DO) or non-physician practitioner (NP, PA, CNS) may provide the professional interpretation of CGM. If services are being reported as “incident to” by the NP, PA, or CNS, all guidelines must be followed, and non-physician practitioners must be practicing within their “scope” of practice.

Can a nurse or CDE download the data from a personally or professionally owned CGM device?

  • Yes.

How is a “qualified healthcare provider” defined?

  • The CPT book defines a qualified healthcare professional as an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his or her scope of practice and independently reports that professional service. These professionals are distinct from “clinical staff".

How is a “clinical staff” person defined?

  • The CPT book defines clinical staff as a person who works under the supervision of a physician or other qualified healthcare professional, and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specific professional service but does not individually report that professional service.

What information needs to be included on the prescription for the DME CGM personally owned device?

The written order for DME items/supplies must include the following:

  • The beneficiary’s name
  • The DME item ordered
  • The prescribing practitioner’s National Provider Identifier (NPI)
  • The signature of the ordering practitioner and
  • The date of the order

Can I count the interpretation and report of the CGM data in my MDM and get points for if performed on the same date as an E/M?

  • No.

CPT® Code 95249

How many times can I report CPT code 95249?

  • CPT guidelines indicate CPT code 95249 may not be reported more than once for the duration that the patient owns the data receiver. Obtaining a new sensor and/or transmitter without a change in the receiver does not warrant reporting 95249 subsequent times.

What is required to be documented in the order to report CPT code 95249?

  • A patient must bring the data receiver into the physician or other qualified healthcare professional’s office where the entire initial data collection process is performed. When following CPT guidelines, all elements described in the CPT code description must be performed to appropriately report the code to insurance carriers so the correct date of service for CPT code 95249 is the date the CGM recording is printed in the office. CPT guidelines further indicate CPT code 95249 may not be reported more than once for the duration that the patient owns the data receiver. Obtaining a new sensor and/or transmitter without a change in the receiver does not warrant reporting 95249 subsequent times.

Can I report CPT code 95249 and CPT code 99091 for insulin pump collection and download?

  • No, code(s) 99091 and/or 0446T should not be reported in addition to code 95249. If a separate and significant evaluation and management (E/M) service is performed on the same date, a modifier 25 may be required to be added to the E/M code.

Does the sensor have to be removed to report code 95249?

  • No.

Can an MA, RN, LPN, CDE perform the elements in CPT code 95249/95250?

  • For Medicare - An MA, RN, LPN, or CDE may perform the elements in CPT codes 95249/95250 if “incident to guidelines” are met, meaning they are providing the service directed by a physician or other qualified healthcare provider.
  • Commercial carriers’ guidelines/requirements/restrictions must be reviewed to determine appropriate credentialing/licensure/scopes of practice, etc.

CPT® code 95250

How do I bill CPT® code 95250 if there is less than 72 hours of data accumulated?

  • Modifier 52 may be used on CPT® code 95250, which indicates that the patient monitoring was less than 72 hours. AACE also recommends checking with your commercial payers to verify whether they require modifier 52 in this situation. Office notes may need to be submitted when modifier 52 is used.

What is the appropriate date of service to use for CPT® code 95250?

  • All elements defined in the CPT description must be completed in order to appropriately report a service or procedure using a CPT code. The date when all elements in the description are completed is the appropriate date of service to report 95250.

How many times per month can I report CPT® code 95250?

  • CPT code 95250 is reported once per month.

Does the sensor have to be removed to report 95250?

  • Yes.

Can CPT® codes 95250 and 95251 be billed on the same date of service?

  • Yes, there is no current editing in place to prevent these services from being billed on the same date of service.

Can an MA, RN, LPN, CDE perform the elements in CPT code 95249/95250?

  • For Medicare - A MA, RN, LPN, or CDE may perform the elements in CPT codes 95249/95250 if “incident to guidelines” are met, meaning they are providing the service directed by a physician or other qualified healthcare provider.
  • Commercial carriers’ guidelines/requirements/restrictions must be reviewed to determine appropriate credentialing/licensure/scopes of practice, etc.

Is the physician or other qualified healthcare provider required to perform an E/M service on the same day as CPT® code 99249/95250?

  • No.

Can I report an E/M with codes 95249-95251?

  • An E/M CPT code (99201-99205, 99211-99215, 99241-99245) may be reported with CPT® codes 95249-95251 if documentation supports the medical necessity of a significant and separately identifiable evaluation and management service performed the same date as the CGM service(s).
  • Modifier 25 may need to be added to the E/M code if 95249-95251 is reported on the same date of service. Physicians may not count the interpretation and report of the CGM data in their Medical Decision-Making portion of the E/M if reporting CPT® code 95251 on the same date as an E/M service.

Can I report CPT® code 99091 in conjunction with CPT® codes 95250 and 95251?

  • No, CPT® code 99091 cannot be reported in conjunction with CPT® codes 95249, 95250 and /or 95251.

CPT® Code 95251

Can an RN, MA or CDE provide the analysis, interpretation and report of a CGM and report code 95251?

  • No, only physicians and other qualified healthcare professionals provide analysis, interpretation and report of CGM data.

Do I have to perform an E/M on the same day as CPT® code 95251?

  • No.

What is the correct date of service to use when reporting CPT® code 95251?

  • The date of service is the date the physician (or qualified non-physician practitioner) interpreted the data and provided a separate written report with appropriate authentication.

Can a physician (or non-physician practitioner practicing within their scope of practice) report CPT® code 95251 on a patient that has not been seen in their office?

  • Yes, as long as there is a minimum of 72 hours of data downloaded and the physician (or non-physician practitioner) provided the interpretation and report. All appropriate signature guidelines must be followed.

What is included with CPT® code 95251?

  • CPT® code 95251 is the analysis, interpretation and report for CGM for a minimum of 72 hours of data. An appropriate CGM analysis, interpretation and report should include the following elements:
  • Patient’s name
  • Date of birth
  • Medical Record #
  • Indication for the device placement
  • Name/Type of device placed
  • Sensor placement date; Sensor removal date (Physician provided equipment)
  • Start date of recording; End date of recording (Patient provided equipment)
  • Date of printout of data (which would be the date of service for 95250/95249 to be reported)
  • Analysis of data
  • Interpretation of data
  • Signature of interpreting physician or other qualified healthcare professional
  • The report must be signed by the physician (or non-physician practitioner practicing within their scope) who is interpreting the report. All signature rules apply.

How many times can I report CPT® code 95251?

  • CPT® code 95251 can only be reported once per month.

Can I report CPT® code 95251 each time a minimum of 72 hours of CGM data is interpreted and reported?

  • No - CPT® code 95251 can only be reported once per month.

Can I report CPT® code 99091 in conjunction with CPT® codes 95250 and 95251?

  • No - CPT® code 99091 cannot be reported in conjunction with CPT® codes 95249, 95250 and /or 95251.

CPT® Code 99091

What CPT code reports the insulin pump analysis and interpretations?

  • Currently, there are no CPT codes for insulin pump analysis and interpretations. Physicians could consider code 99091 for this service. The CPT description for code 99091 is “Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.

Can 99091 be reported with the CGM code(s)95249, 95250, or 95251?

  • No.

Can code 99091 be reported multiple times in a month?

  • No - code 99091 can only be reported once in a 30-day period.

What is included with code 99091?

  • Code 99091 includes the physician or other qualified health care professional’s time involved with data accession, review and interpretation, modification of care plan as necessary (including communication to patient and/or caregiver), and associated documentation. This is a time-based code and requires exact times to be indicated in the documentation.

Can 99091 be reported on the same date as an E/M is reported?

  • No, these services are currently considered part of the E/M service and not separately reported. Do not report 99091 if other more specific CPT codes exist (e.g., 93227, 93272 for cardiographic services; 95250/95251 for continuous glucose monitoring). Do not report 99091 for transfer and interpretation of data from hospital or clinical laboratory computers.

What are the documentation requirements for 99091?

  • The documentation suggested for 99091 may include the device type, how the data was stored and transmitted, the amount of time it took for the data to be transmitted, the amount of time the provider or other qualified healthcare professional took to review and interpret the data. Also remember that an interpretation requires a report and not just a print out of the data reviewed. Anytime CPT indicates an exact time in a description, auditors will automatically look for documentation of time to support the use of the code.

Can I report CPT® code 99091 in conjunction with CPT® codes 95250 and 95251?

  • No, CPT® code 99091 cannot be reported in conjunction with CPT® codes 95249, 95250 and/or 95251.

AACE DISCLAIMER

Please note that any AACE proprietary information or intellectual property may not be shared with any third party or utilized in any manner without the expressed written consent of AACE. All medical coding must be supported with documentation and medical necessity.

**While this represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations. As CPT® ICD-10-CM and HCPCS codes change annually, you should reference the current CPT® ICD-10-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information.

This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only.

Current Procedural Terminology (CPT®) is copyright and trademark of the 2017 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.