2025 CPT code 95249
Effective Date: N/A Medicine Services and Procedures - Endocrinology Services Medicine Feed
Ambulatory continuous glucose monitoring 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.
Modifiers may be applicable. Refer to current CPT guidelines for appropriate usage.
Medical necessity must be established for CGM. This may include documentation of uncontrolled diabetes, hypoglycemia unawareness, or the need for frequent glucose monitoring.
The physician or other qualified healthcare professional is responsible for sensor insertion, device setup and calibration, patient education, sensor removal, data download, and report generation.
In simple words: The doctor inserts a small sensor under the patient's skin to measure their sugar levels continuously for at least 3 days.The patient brings their own monitor. The doctor sets up the monitor, shows the patient how to use it, and removes the sensor after the monitoring period.A printout of the sugar readings is then given to the patient.
This code reports a service where a patient provides their own continuous glucose monitoring (CGM) device. The provider inserts the sensor, connects it, calibrates the device, trains the patient, removes the sensor after at least 72 hours, and provides a printout of the data.The service aims to monitor interstitial glucose levels over an extended period for patients with blood glucose regulation difficulties.
Example 1: A patient with type 1 diabetes brings their own CGM device to the clinic. The provider inserts the sensor, calibrates the device, educates the patient on its use, removes the sensor after 72 hours, and prints the glucose data., A patient struggling with gestational diabetes brings their personal CGM device. The physician provides the service described by 95249, monitoring the patient's glucose levels for at least 72 hours., A patient with type 2 diabetes experiencing fluctuating glucose levels brings their own monitor. The healthcare professional performs the service represented by 95249, capturing data over 72 hours and delivering the results to the patient.
Documentation should include the type of CGM device used, sensor insertion and removal dates and times, calibration records, patient training documentation, and the glucose data printout.
** This code is for patient-provided equipment only.The code only applies to a minimum of 72 hours of monitoring.The code is not billable for subsequent use of same monitor without a new reciever.
- Revenue Code: T1E (LAB TESTS - GLUCOSE)
- Specialties:Endocrinology, Diabetes Management, Internal Medicine, Family Medicine
- Place of Service:Office