CPT code 95249: CGM setup, patient-provided equipment2026 Medicare rate & RVUs in Pennsylvania
Reports setup and patient training for a personal continuous glucose monitor, including sensor placement and device preparation for at least 72 hours of monitoring.
Medicare pays $64.12–$72.87 for 95249 in the office in Pennsylvania, from Rest of Pennsylvania to Metropolitan Philadelphia, PA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 95249 covers
This service covers clinic setup and training for a continuous glucose monitor the patient supplies. Staff prepare the device, place and connect the sensor, calibrate the monitor as needed, teach the patient how to use it, and provide a data printout. It is used for patients with diabetes who are starting or receiving instruction on personal CGM equipment, commonly in endocrinology or diabetes-care practices.
Report 95249 when the patient’s own equipment is used and the monitoring period meets the 72-hour minimum. Documentation should support the patient-provided device, sensor setup, training performed, monitoring duration, and resulting printout. CMS identifies this as a technical-component-only service; report the separate interpretation code when analysis and a report are performed. Do not use this setup code for clinic-provided equipment, which is described by 95250.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 95249 pays more and less in Pennsylvania
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Philadelphia, PA | $72.87 | Unavailable |
| Rest of Pennsylvania | $64.12 | Unavailable |
How the 95249 rate is calculated
Each of 95249’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 95249
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense2.05
2.05 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
2.0900
Conversion factor
$33.4009
Medicare rate
$69.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95249
The CMS indicators that decide how 95249 is paid alongside other services.
CMS payment indicators · 95249
CGM setup, patient-provided equipment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 3 | Technical component only. |
95249 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 95250CGM setupPractice-supplied equipment
- Choose 95249 when the patient provides the CGM equipment; choose 95250 when the physician or qualified health professional provides it.
- 95251CGM interpretationAnalysis, interpretation, and report
- 95249 covers device setup and patient training. 95251 covers analysis, interpretation, and a report based on CGM data.
- 82947Blood glucoseQuantitative, not reagent strip
- 82947 represents a quantitative blood glucose test, not CGM sensor setup or patient training; report it only when that test is separately performed.
95249 billing questions
How is 95249 different from 95250?
95249 is for setup and training using the patient’s own CGM equipment. Use 95250 when the equipment is provided by the physician or qualified health professional.
Does 95249 include interpretation of the CGM data?
No. CMS identifies 95249 as technical-component-only; the separate interpretation and report are covered by 95251 when performed.
What documentation supports reporting 95249?
Document that the patient supplied the equipment, the sensor and monitor setup and training performed, the monitoring period of at least 72 hours, and the resulting printout.
Can 95249 and 95251 be reported together?
They may be reported for the same patient when the setup service and a separate analysis, interpretation, and report are performed and documented.
Is 95249 reported for fewer than 72 hours of monitoring?
The service is defined for monitoring of at least 72 hours. The record should support that duration.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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