{"id":15344,"date":"2022-04-12T16:59:42","date_gmt":"2022-04-12T16:59:42","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15344"},"modified":"2026-05-15T13:07:32","modified_gmt":"2026-05-15T07:37:32","slug":"billing-for-continuous-glucose-monitor-cgm","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/","title":{"rendered":"Billing for Continuous Glucose Monitor (CGM)"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">On December 28, 2021, the Centers for Medicare &amp; Medicaid Services (CMS) published a final rule which was implemented on February 28, 2022. This final rule addressed the classification and payment of continuous glucose monitor (CGMs) under the Medicare Part B benefit for durable medical equipment (DME).<\/span><\/p>\r\n<p><span style=\"font-weight: 400;\">This rule expanded the classification of DME to a larger group of CGMs, regardless of whether the CGMs are non-adjunctive (can replace standard blood glucose monitors for treatment decisions) or adjunctive (do not replace standard blood glucose monitors for treatment decisions). <\/span><\/p>\r\n<p><span style=\"font-weight: 400;\">As such, claims for adjunctive CGMs and related supplies and accessories can now be covered under the Part B DME benefit category when the system meets the DME definition.\u00a0<\/span><\/p>\r\n<h2><strong>Applicable Procedure Codes<\/strong><\/h2>\r\n<p><span style=\"font-weight: 400;\"><strong>There are currently two Current Procedural Terminology (CPT) codes for CGM:<\/strong> 95250 and 95251. CPT 95250 is used for the technical component of Continuous Glucose Monitor and covers patient training, glucose sensor placement, monitor calibration, use of a transmitter, removal of a sensor, and downloading of data. <\/span><\/p>\r\n<p><span style=\"font-weight: 400;\">CPT code 95250 may be appropriate for retrospective CGM and for the initial training, hookup, download, etc. on patient-use CGM.\u00a0 The CPT code 95251 is for the analysis and interpretation of CGM data. This analysis does not need to be performed face-to-face with the patient.<\/span><\/p>\r\n<p><a href=\"tel:888-357-3226\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-18871\" src=\"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2024\/05\/Legacy-AR-MBC-2.jpg\" alt=\"Legacy AR - MBC\" width=\"700\" height=\"200\" \/><\/a><\/p>\r\n<p><span style=\"font-weight: 400;\">However, CPT 95251 is a professional code that is only billable by a physician or midlevel provider (i.e., nurse practitioner or physician assistant).<\/span><\/p>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><strong>CPT 959250 code description:<\/strong> Professional Continuous Glucose Monitor 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 a sensor, and printout of recording.<\/span><\/li>\r\n<\/ul>\r\n<p><span style=\"font-weight: 400;\">CPT 95250 can be billed by any qualified staff member under the direct supervision of a physician, a physician assistant, or a nurse practitioner.\u00a0<\/span><\/p>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><strong>CPT 959251 code description:<\/strong> CGM Interpretation Ambulatory CGM of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.<\/span><\/li>\r\n<\/ul>\r\n<p><span style=\"font-weight: 400;\">CPT 95251 can be billed by Physicians, Physician Assistants, and Nurse Practitioners.\u00a0<\/span><\/p>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"><strong>Modifier -25:<\/strong> An EM 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 on 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.<\/span><\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Code limitations:\u00a0<\/strong>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>CPT codes 95250 and 95251<\/strong> are defined as a minimum of 72 hours; neither code can be assigned or billed if a CGM of less than 72 hours is provided.<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>CPT codes 95250 and 95251<\/strong> cannot be reported more than once per month per patient regardless of the duration of professional CGM or the number of times CGM is provided in a single month.<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E\/M<\/strong> can only be billed separately on the same day when a significant and separately identifiable service took place above and beyond the services associated with CGM.<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>Use modifier \u201c-25\u201d with E\/M code<\/strong> when billing 95250 and 95251 on the same day<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h2><strong>Other Billing Details for CGM<\/strong><\/h2>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Document the primary diagnosis code and the appropriate ICD indicator based on the date of service. Example diagnosis code: 250.03 (Diabetes without mention of complications; type 1, uncontrolled. <\/span><\/span><strong>Common ICD-10 codes include:<\/strong>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E10.649<\/strong> Type 1 diabetes mellitus with hypoglycemia without coma<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E10.65<\/strong> Type 1 diabetes mellitus with hyperglycemia<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E10.69<\/strong> Type 1 diabetes mellitus with other specified complications<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E10.8<\/strong> Type 1 diabetes mellitus with unspecified complications<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E10.9<\/strong> Type 1 diabetes mellitus without complications<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E11.649<\/strong> Type 2 diabetes mellitus with hypoglycemia without coma<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E11.65<\/strong> Type 2 diabetes mellitus with hyperglycemia<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E11.69<\/strong> Type 2 diabetes mellitus with other specified complications<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E11.8<\/strong> Type 2 diabetes mellitus with unspecified complications<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E11.9<\/strong> Type 2 diabetes mellitus without complications<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><strong>E13.8<\/strong> Other diabetes mellitus with unspecified complications<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"><strong>E13.9<\/strong> Other specified diabetes mellitus without complications<\/span><\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Specify the location where the service was performed Examples include, POS 11 and POS Office 22 for outpatient hospital<\/span><\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"><strong>Documentation:<\/strong> It may vary as per payer but standard documentation for CGM includes the following:<\/span><\/span>\r\n<ul>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Documented glycemic control problems\u00a0<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Description of a patient treatment plan\u00a0<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Record of patient\u2019s adherence to plan\u00a0<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Physician progress notes\u00a0<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Evaluations and consultations related to the diagnosis\u00a0<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Laboratory reports, including HbA1c<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Blood glucose logs\u00a0<\/span><\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Physician report with interpretation and findings based on information obtained during monitoring<\/span><\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Always verify benefits for every patient visit and check for requirements of the prior authorization request.<\/span><\/li>\r\n<\/ul>\r\n<p><a href=\"https:\/\/www.medicalbillersandcoders.com\/\"><b>Medical Billers and Coders (MBC)<\/b><\/a><span style=\"font-weight: 400;\"> is a leading medical billing company providing complete revenue cycle services. To learn more about our medical billing and coding services, email us at: <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a> or call us at: <a href=\"tel:888-357-3226\"><strong>888-357-3226<\/strong><\/a><\/span><\/p>\r\n<p><span style=\"font-weight: 400;\"><strong>Reference:<\/strong> \u00a0<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2769770\/#:~:text=CPT%2095250%20is%20used%20for,%2C%20hookup%2C%20download%2C%20etc.\"><span style=\"font-weight: 400;\">Continuous Glucose Monitoring (CGM): Understanding the Fundamentals<\/span><\/a><\/p>\r\n<h2>FAQs<\/h2>\r\n\r\n<div class=\"schema-faq wp-block-yoast-faq-block\">\r\n<div id=\"faq-question-1745589552744\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">1. What is the main change in the classification of Continuous Glucose Monitors (CGMs) under Medicare Part B?<\/strong>\r\n<p class=\"schema-faq-answer\">On December 28, 2021, CMS expanded the classification of CGMs under Medicare Part B to include both non-adjunctive and adjunctive CGMs. This change means that adjunctive CGMs can now be covered under the Part B DME benefit if they meet the DME definition.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589571359\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">2. What are the CPT codes for Continuous Glucose Monitors?<\/strong>\r\n<p class=\"schema-faq-answer\">CPT code 95250 covers the technical component of CGM, including patient training, sensor placement, monitor calibration, and data downloading. CPT code 95251 is used for the analysis and interpretation of CGM data and can be billed by physicians, physician assistants, or nurse practitioners.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589584859\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">3. Can you bill for a CGM if it is used for less than 72 hours?<\/strong>\r\n<p class=\"schema-faq-answer\">No, CPT codes 95250 and 95251 require a minimum of 72 hours of CGM use. If the CGM is used for less than 72 hours, these codes cannot be billed.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589600271\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">4. How should you document CGM services for billing purposes?<\/strong>\r\n<p class=\"schema-faq-answer\">Documentation should include glycemic control problems, a treatment plan, patient adherence records, physician progress notes, evaluations, laboratory reports, blood glucose logs, and a report with interpretation and findings.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589612485\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">5. Can you bill for an Evaluation and Management (E\/M) service on the same day as CGM codes?<\/strong>\r\n<p class=\"schema-faq-answer\">Yes, you can bill for an E\/M service on the same day as CGM codes 95250 and 95251 if there is a significant and separately identifiable service performed. Use modifier -25 to indicate this.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589624681\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">6. What are some common ICD-10 codes used with CGM services?<\/strong>\r\n<p class=\"schema-faq-answer\">Common ICD-10 codes include E10.649 (Type 1 diabetes with hypoglycemia without coma), E11.65 (Type 2 diabetes with hyperglycemia), and E13.9 (Other specified diabetes mellitus without complications).<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589643228\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">7. What should you verify before providing CGM services?<\/strong>\r\n<p class=\"schema-faq-answer\">Always verify benefits and check for prior authorization requirements for each patient visit to ensure coverage and compliance with payer guidelines.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589658829\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">8. Who can bill for continuous glucose monitoring (CGM)?<\/strong>\r\n<p class=\"schema-faq-answer\">CPT code 95250, which covers the technical component of CGM, can be billed by any qualified staff member under the direct supervision of a physician, physician assistant, or nurse practitioner. CPT code 95251, which involves the analysis and interpretation of CGM data, can only be billed by physicians, physician assistants, or nurse practitioners.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1745589670200\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">9. How often can you bill for CGM?<\/strong>\r\n<p class=\"schema-faq-answer\">CPT codes 95250 and 95251 can be billed a maximum of once per month per patient. Additionally, the CGM must be used for a minimum of 72 hours for these codes to be applicable.<\/p>\r\n<\/div>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"<p>On December 28, 2021, the Centers for Medicare &amp; Medicaid Services (CMS) published a final rule which was implemented on February 28, 2022. This final rule addressed the classification and payment of continuous glucose monitor (CGMs) under the Medicare Part B benefit for durable medical equipment (DME). This rule expanded the classification of DME to [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":15345,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[3359,3360,51,3361,120,3363,908,82,162,806,1159],"class_list":["post-15344","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-cgm","tag-cgm-interpretation-ambulatory","tag-cms","tag-continuous-glucose-monitor-cgms","tag-cpt-code","tag-cpt-code-95251","tag-durable-medical-equipment","tag-icd-10-codes","tag-medical-billing-and-coding-services","tag-medicare-part-b","tag-modifier-25"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Billing for Continuous Glucose Monitor (CGM)<\/title>\n<meta name=\"description\" content=\"Understanding the recent CMS final rule on continuous glucose monitors (CGMs) under Medicare Part B. 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If the CGM is used for less than 72 hours, these codes cannot be billed.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589600271","position":4,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589600271","name":"4. How should you document CGM services for billing purposes?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Documentation should include glycemic control problems, a treatment plan, patient adherence records, physician progress notes, evaluations, laboratory reports, blood glucose logs, and a report with interpretation and findings.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589612485","position":5,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589612485","name":"5. Can you bill for an Evaluation and Management (E\/M) service on the same day as CGM codes?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes, you can bill for an E\/M service on the same day as CGM codes 95250 and 95251 if there is a significant and separately identifiable service performed. 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What are some common ICD-10 codes used with CGM services?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Common ICD-10 codes include E10.649 (Type 1 diabetes with hypoglycemia without coma), E11.65 (Type 2 diabetes with hyperglycemia), and E13.9 (Other specified diabetes mellitus without complications).","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589643228","position":7,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589643228","name":"7. What should you verify before providing CGM services?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Always verify benefits and check for prior authorization requirements for each patient visit to ensure coverage and compliance with payer guidelines.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589658829","position":8,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589658829","name":"8. Who can bill for continuous glucose monitoring (CGM)?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 95250, which covers the technical component of CGM, can be billed by any qualified staff member under the direct supervision of a physician, physician assistant, or nurse practitioner. CPT code 95251, which involves the analysis and interpretation of CGM data, can only be billed by physicians, physician assistants, or nurse practitioners.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589670200","position":9,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-continuous-glucose-monitor-cgm\/#faq-question-1745589670200","name":"9. How often can you bill for CGM?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT codes 95250 and 95251 can be billed a maximum of once per month per patient. Additionally, the CGM must be used for a minimum of 72 hours for these codes to be applicable.","inLanguage":"en-US"},"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/15344","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/comments?post=15344"}],"version-history":[{"count":12,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/15344\/revisions"}],"predecessor-version":[{"id":29698,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/15344\/revisions\/29698"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media\/15345"}],"wp:attachment":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media?parent=15344"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/categories?post=15344"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/tags?post=15344"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}