2025 CPT code 95250
(Active) Effective Date: N/A Revision 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; 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.
Modifier 25 can be applied to an E/M service provided on the same day to indicate a significant, separately identifiable E/M service.
Medical necessity for CGM is determined by the patient's clinical condition and the need for continuous glucose data to optimize diabetes management. Conditions such as unstable or brittle diabetes, frequent hypoglycemic or hyperglycemic episodes despite conventional management, and assessment of new treatments may justify the use of CGM.
The physician or qualified healthcare professional is responsible for providing the CGM device, inserting the sensor, ensuring proper device calibration and patient training on its usage, removing the sensor after the monitoring period, downloading the data, and providing a printout of the recorded glucose data to the patient and/or other healthcare providers involved in their care. This role emphasizes the technical aspects of CGM usage and not the professional interpretation.
In simple words: A small sensor is inserted under your skin to continuously monitor your glucose levels for at least 72 hours.The doctor's office provides the device, inserts it, shows you how to use it, removes it, and gives you a report of your glucose levels.
This code pertains to ambulatory continuous glucose monitoring (CGM) utilizing a subcutaneous sensor placed in the interstitial tissue fluid, for a minimum duration of 72 hours.The service includes the provision of equipment by the physician's office or other qualified healthcare professional's office. The procedure encompasses sensor placement, connection to the monitoring device, calibration of the device, training provided to the patient on the CGM device functions and management, and finally, removal of the sensor and generation of a printout summarizing the recorded data.This code is intended for use when the CGM device and supplies (sensor, transmitter) are provided by the healthcare professional’s office.
Example 1: A patient with type 1 diabetes struggling with fluctuating glucose levels is prescribed CGM for better glucose management. The physician's office provides the CGM device and performs the sensor insertion, device setup, patient education, sensor removal, and data downloading., A pregnant woman with gestational diabetes requires close monitoring of her glucose levels. The physician provides a CGM device from their office and carries out the necessary procedures for data collection., A patient with type 2 diabetes is starting on a new medication, and the physician wishes to monitor their glucose response over several days. The patient receives a CGM device from the physician's office for this purpose.
Proper documentation for 95250 should include the type of CGM device used, the date and time of sensor insertion and removal, the location of sensor placement, any difficulties encountered during the procedure, patient training provided, and the printout of the CGM data.The medical record should also include the medical necessity for the CGM, such as uncontrolled diabetes, frequent hypo- or hyperglycemic episodes, or the need to assess the efficacy of a new medication or treatment regimen.
- Revenue Code: T1E - LAB TESTS - GLUCOSE
- Payment Status: Active
- Modifier TC rule: This code represents only the technical component. Do not use modifier TC or 26.
- Specialties:Endocrinology, Diabetes Management, Internal Medicine, Family Medicine, Pediatrics
- Place of Service:Office