2025 CPT code 95251
(Active) Effective Date: N/A Revision Date: N/A Medicine - Endocrinology Services Medicine Services and Procedures Feed
Analysis and interpretation of continuous glucose monitoring (CGM) data with a written report; minimum 72 hours of data required.
Modifiers may be applicable depending on the circumstances of service. Consult the most recent CPT codebook for appropriate modifiers.
Medical necessity for CPT code 95251 is established when CGM data analysis and interpretation are crucial for optimizing the patient's diabetes management and preventing potential complications.This is particularly relevant for patients with complex diabetes management needs, those experiencing frequent hypoglycemic or hyperglycemic events, or those requiring close monitoring during critical periods like pregnancy or illness.
The clinical responsibility lies with the physician or qualified healthcare professional who reviews, analyzes, interprets the CGM data, and creates a written report for the patient's medical management.
In simple words: The doctor or nurse practitioner reviews the information from your continuous glucose monitor (CGM), which tracks your blood sugar levels for at least 72 hours. They'll analyze the results and write a report explaining what the data means and how it can help manage your diabetes treatment.
This CPT code reports the professional component of analyzing and interpreting data from a patient's continuous glucose monitor (CGM) for at least 72 hours.The provider reviews the collected data, analyzes trends, interprets the results, and generates a comprehensive written report.This report should include an assessment of current treatment and recommendations for adjustments based on the CGM data.The code does not include the technical aspects of CGM setup, data download, or sensor placement (CPT code 95250 covers those aspects).
Example 1: A patient with type 1 diabetes uses a CGM for 72 hours.The endocrinologist reviews the data, identifies patterns of hyper- and hypoglycemia, and adjusts insulin dosages accordingly. A detailed report outlining the findings and recommendations is generated., A patient with gestational diabetes utilizes CGM monitoring throughout her pregnancy. The obstetrician reviews the data, detects trends of elevated blood glucose levels, and recommends dietary changes and increased blood glucose monitoring. The findings and treatment plans are documented in a comprehensive report., A patient with type 2 diabetes on multiple medications undergoes CGM monitoring. The primary care physician reviews the data remotely, observing patterns suggesting medication non-compliance, and schedules a meeting to discuss the findings and initiate a behavioral intervention program. The report details the data interpretation and treatment modification plan.
* Detailed CGM data report for at least 72 hours.* Provider's interpretation and analysis of the CGM data.* Specific recommendations for patient management based on the interpretation of the CGM data.* Patient's medical record demonstrating the diagnosis of diabetes or other related conditions requiring CGM monitoring.
** Payers may have specific coverage requirements and limitations regarding the frequency of billing for this code. Always refer to payer-specific guidelines for reimbursement.
- Payment Status: Active
- Modifier TC rule: Modifier 26 (professional component) is not necessary for this code as it is already a professional component only. Modifier TC (technical component) is not applicable.
- Specialties:Endocrinology, Diabetes Management, Internal Medicine, Family Medicine, Obstetrics/Gynecology (in the context of gestational diabetes)
- Place of Service:Office, Hospital, Clinic, Telehealth