Medicare Compliance & Reimbursement

Question: What is the best way to bill for continuous glucose monitoring? Do we bill for the initial visit and when the patient returns to the office after five days of monitoring, or report only one visit?

Answer: You can bill for both dates of service related to continuous glucose monitoring (CGM). The codes are:

• 95250 -- Ambulatory continuous glucose monitoring of interstitial tissue 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
• 95251 -- Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report.

Initial day: Report 95250 for the initial placement of the CGM and related patient training. If a significant, separately identifiable E/M service is provided at the same encounter, you may also submit the appropriate E/M code, such as 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...).

Follow up: When the patient returns, report 95251 for the interpretation and report. Do not report 95250 again, because the removal and printout are already covered by your previous reporting of this code. As with the initial visit, include the appropriate office visit E/M code from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) if there is a significant, separately identifiable E/M service (such as, for the time your provider takes to explain the results to the patient).