2014 Continuous Glucose Monitoring (CGM) Coding Reference
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2014 Continuous Glucose Monitoring (CGM) Coding Reference Description Medicare2 Outpatient Diabetes Center Paid under physican fee schedule Ambulatory continuous glucose monitoring of interstitial fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording. (Do not report more than once per month) Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report. (Do not report more than once per month) Evaluation and Management (E/M) Codes 99211-99215 Established Patient Visit or G0463 (Medicare Outpatient Clinic Visits) (Medicare Outpatient Clinic Visits) * Non-facility is defined as a free standing center or non-hospital. What type of healthcare provider/physician can bill CPT codes 95250 and 95251? CPT code 95250 does not have any physician work RVUs (Relative Value Units); therefore the services associated with 95250 can be performed by a trained RN, PharmD/RPh, RD, CDE or MA (if within their scope of practice) and billed by the supervising physician or hospital outpatient department. However, only providers such as Physician (MD), Nurse Practitioner (NP), Physician Assistant (PA) or Clinical Nurse Specialist (CNS) can perform and bill for services associated with CPT code 95251. What is the difference between the Medicare physician fee schedule and the outpatient diabetes center payment? Medicare physician payments are fee schedules based on relative value units (RVUs). Hospital outpatient services are paid under the outpatient prospective payment system (OPPS). CPT code 95250 is paid under Ambulatory Procedure Classification (APC) 0634 with 2014 national average payment of $93. The Medicare fee schedules provided in the table above are national averages. Where would healthcare providers find the local Medicare fee schedules for physicians in their state? The Center for Medicare and Medicaid (CMS) has a search engine that you can find state and local fee schedules for all CPT codes. The website is http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp Dexcom | Corporate Headquarters 6340 Sequence Drive San Diego CA 92121 www.dexcom.com | 888.738.3646

Can physicians bill the CGM CPT codes (95250 and 95251) for training on CGM personal use devices? The CPT codes 95250 and 95251 are not product-specific. CPT code 95250 reflects costs and services associated with the patient training, hook-up and calibration, sensor removal and data download. CPT code 95251 reflects the physician services associated with the interpretation and report for CGM. Services associated with CPT code 95251 may be a non-face-to-face service.4 It is recommended that healthcare providers check with their local insurance carriers to determine how personal CGM should be...