CPT code 95251: CGM interpretation, analysis, interpretation, and report2026 Medicare rate & RVUs in Montana
Physician or qualified practitioner review, interpretation, and written report of at least 72 hours of continuous glucose monitoring data from patient-owned or practice-provided equipment.
In Montana, Medicare pays $35.07 for 95251 in the office and $35.07 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 95251 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 95251 covers
This service is the clinician's evaluation of at least 72 hours of interstitial glucose readings recorded by a subcutaneous sensor. A physician, nurse practitioner, or physician assistant reviews a downloaded or remotely uploaded ambulatory glucose profile from a Dexcom, FreeStyle Libre, or similar system. The practitioner assesses time in range, low and high glucose excursions, overnight and postprandial patterns, and variability, then writes patient-specific findings and recommendations such as insulin dose or timing changes. Endocrinology and primary care practices perform these reviews for patients with type 1 or insulin-treated type 2 diabetes.
Report 95251 no more than once per month for a monitoring period of at least 72 hours, even if data are reviewed multiple times. Document the monitoring dates and a signed interpretation; a device printout without clinical analysis is insufficient. CMS classifies 95251 as professional-component-only, covering analysis, interpretation, and report; do not append modifier 26. When performed, patient-owned CGM startup and training are described by 95249, while 95250 describes setup and recording using practice-provided equipment. Neither technical service is required for 95251 when a patient's existing device provides the data.
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.
How Montana compares for 95251
Across 109 of 109 payment localities, the office rate for 95251 runs from $32.75 in Arkansas to $46.37 in Alaska. Montana pays $35.07. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$35.07
- Los Angeles, CA · California$37.40+$2.33
- Washington, DC area · District of Columbia$38.39+$3.32
- Miami, FL · Florida$38.06+$2.99
- Chicago, IL · Illinois$37.45+$2.38
- Manhattan, NY · New York$39.23+$4.16
- Alaska · Alaska$46.37+$11.30
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $33.01 | $33.01 |
| ArkansasArkansas | $32.75 | $32.75 |
| ArizonaArizona | $34.50 | $34.50 |
| Bakersfield, CACalifornia | $35.88 | $35.88 |
| Chico, CACalifornia | $35.71 | $35.71 |
| El Centro, CACalifornia | $35.72 | $35.72 |
| Fresno, CACalifornia | $35.71 | $35.71 |
| Hanford, CACalifornia | $35.71 | $35.71 |
| Madera, CACalifornia | $35.71 | $35.71 |
| Merced, CACalifornia | $35.71 | $35.71 |
| Modesto, CACalifornia | $35.71 | $35.71 |
| Napa, CACalifornia | $39.08 | $39.08 |
| Oxnard, CACalifornia | $37.02 | $37.02 |
| Redding, CACalifornia | $35.71 | $35.71 |
| Rest of CaliforniaCalifornia | $35.71 | $35.71 |
| Riverside, CACalifornia | $36.26 | $36.26 |
| Sacramento, CACalifornia | $36.86 | $36.86 |
| Salinas, CACalifornia | $36.70 | $36.70 |
| San Diego, CACalifornia | $37.08 | $37.08 |
| Marin County, CACalifornia | $40.71 | $40.71 |
| San Francisco, CACalifornia | $40.65 | $40.65 |
| San Benito County, CACalifornia | $41.52 | $41.52 |
| Santa Clara County, CACalifornia | $41.29 | $41.29 |
| San Luis Obispo, CACalifornia | $36.17 | $36.17 |
| Santa Cruz, CACalifornia | $37.07 | $37.07 |
| Santa Maria, CACalifornia | $36.71 | $36.71 |
| Santa Rosa, CACalifornia | $37.41 | $37.41 |
| Stockton, CACalifornia | $35.71 | $35.71 |
| Vallejo, CACalifornia | $39.00 | $39.00 |
| Visalia, CACalifornia | $35.71 | $35.71 |
| Yuba City, CACalifornia | $35.71 | $35.71 |
| ColoradoColorado | $35.66 | $35.66 |
| ConnecticutConnecticut | $36.70 | $36.70 |
| DelawareDelaware | $34.89 | $34.89 |
| Fort Lauderdale, FLFlorida | $36.56 | $36.56 |
| Rest of FloridaFlorida | $35.44 | $35.44 |
| Atlanta, GAGeorgia | $35.65 | $35.65 |
| Rest of GeorgiaGeorgia | $34.24 | $34.24 |
| Hawaii, Guam, HIHawaii | $35.83 | $35.83 |
| IowaIowa | $33.16 | $33.16 |
| IdahoIdaho | $33.34 | $33.34 |
| East St. Louis, ILIllinois | $35.91 | $35.91 |
| Rest of IllinoisIllinois | $35.08 | $35.08 |
| Suburban Chicago, ILIllinois | $36.81 | $36.81 |
| IndianaIndiana | $33.43 | $33.43 |
| KansasKansas | $33.22 | $33.22 |
| KentuckyKentucky | $33.74 | $33.74 |
| New Orleans, LALouisiana | $34.67 | $34.67 |
| Rest of LouisianaLouisiana | $33.77 | $33.77 |
| Metropolitan Boston, MAMassachusetts | $37.89 | $37.89 |
| Rest of MassachusettsMassachusetts | $35.66 | $35.66 |
| Baltimore area, MDMaryland | $36.61 | $36.61 |
| Rest of MarylandMaryland | $35.29 | $35.29 |
| Rest of MaineMaine | $33.58 | $33.58 |
| Southern Maine, MEMaine | $34.36 | $34.36 |
| Detroit, MIMichigan | $35.84 | $35.84 |
| Rest of MichiganMichigan | $34.36 | $34.36 |
| MinnesotaMinnesota | $34.21 | $34.21 |
| Metropolitan Kansas City, MOMissouri | $34.38 | $34.38 |
| Metropolitan St. Louis, MOMissouri | $34.56 | $34.56 |
| Rest of MissouriMissouri | $33.55 | $33.55 |
| MississippiMississippi | $33.15 | $33.15 |
| North CarolinaNorth Carolina | $33.75 | $33.75 |
| North DakotaNorth Dakota | $34.08 | $34.08 |
| NebraskaNebraska | $33.21 | $33.21 |
| New HampshireNew Hampshire | $35.30 | $35.30 |
| Northern New JerseyNew Jersey | $38.33 | $38.33 |
| Rest of New JerseyNew Jersey | $37.12 | $37.12 |
| New MexicoNew Mexico | $34.52 | $34.52 |
| NevadaNevada | $34.80 | $34.80 |
| NYC suburbs and Long Island, NYNew York | $39.98 | $39.98 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $37.46 | $37.46 |
| Queens, NYNew York | $39.21 | $39.21 |
| Rest of New YorkNew York | $34.04 | $34.04 |
| OhioOhio | $34.15 | $34.15 |
| OklahomaOklahoma | $33.55 | $33.55 |
| Portland, OROregon | $36.19 | $36.19 |
| Rest of OregonOregon | $34.53 | $34.53 |
| Metropolitan Philadelphia, PAPennsylvania | $36.24 | $36.24 |
| Rest of PennsylvaniaPennsylvania | $34.10 | $34.10 |
| Puerto RicoPuerto Rico | $35.16 | $35.16 |
| Rhode IslandRhode Island | $35.67 | $35.67 |
| South CarolinaSouth Carolina | $34.01 | $34.01 |
| South DakotaSouth Dakota | $33.96 | $33.96 |
| TennesseeTennessee | $33.33 | $33.33 |
| Austin, TXTexas | $35.55 | $35.55 |
| Beaumont, TXTexas | $33.99 | $33.99 |
| Brazoria, TXTexas | $34.79 | $34.79 |
| Dallas, TXTexas | $35.00 | $35.00 |
| Fort Worth, TXTexas | $34.91 | $34.91 |
| Galveston, TXTexas | $34.89 | $34.89 |
| Houston, TXTexas | $35.81 | $35.81 |
| Rest of TexasTexas | $34.36 | $34.36 |
| UtahUtah | $34.26 | $34.26 |
| VirginiaVirginia | $34.40 | $34.40 |
| Virgin Islands, VIUnited States Virgin Islands | $35.16 | $35.16 |
| VermontVermont | $34.14 | $34.14 |
| Rest of WashingtonWashington | $35.53 | $35.53 |
| King County, WAWashington | $38.33 | $38.33 |
| WisconsinWisconsin | $33.47 | $33.47 |
| West VirginiaWest Virginia | $34.39 | $34.39 |
| WyomingWyoming | $34.64 | $34.64 |
95251 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$32.75
$46.37
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $46.37 | 1 |
| AL | $33.01 | 1 |
| AR | $32.75 | 1 |
| AZ | $34.50 | 1 |
| CA | $35.71–$41.52 | 29 |
| CO | $35.66 | 1 |
| CT | $36.70 | 1 |
| DC | $38.39 | 1 |
| DE | $34.89 | 1 |
| FL | $35.44–$38.06 | 3 |
| GA | $34.24–$35.65 | 2 |
| GU | $35.83 | 1 |
| HI | $35.83 | 1 |
| IA | $33.16 | 1 |
| ID | $33.34 | 1 |
| IL | $35.08–$37.45 | 4 |
| IN | $33.43 | 1 |
| KS | $33.22 | 1 |
| KY | $33.74 | 1 |
| LA | $33.77–$34.67 | 2 |
| MA | $35.66–$37.89 | 2 |
| MD | $35.29–$38.39 | 3 |
| ME | $33.58–$34.36 | 2 |
| MI | $34.36–$35.84 | 2 |
| MN | $34.21 | 1 |
| MO | $33.55–$34.56 | 3 |
| MS | $33.15 | 1 |
| MT | $35.07 | 1 |
| NC | $33.75 | 1 |
| ND | $34.08 | 1 |
| NE | $33.21 | 1 |
| NH | $35.30 | 1 |
| NJ | $37.12–$38.33 | 2 |
| NM | $34.52 | 1 |
| NV | $34.80 | 1 |
| NY | $34.04–$39.98 | 5 |
| OH | $34.15 | 1 |
| OK | $33.55 | 1 |
| OR | $34.53–$36.19 | 2 |
| PA | $34.10–$36.24 | 2 |
| PR | $35.16 | 1 |
| RI | $35.67 | 1 |
| SC | $34.01 | 1 |
| SD | $33.96 | 1 |
| TN | $33.33 | 1 |
| TX | $33.99–$35.81 | 8 |
| UT | $34.26 | 1 |
| VA | $34.40–$38.39 | 2 |
| VI | $35.16 | 1 |
| VT | $34.14 | 1 |
| WA | $35.53–$38.33 | 2 |
| WI | $33.47 | 1 |
| WV | $34.39 | 1 |
| WY | $34.64 | 1 |
How the 95251 rate is calculated
Each of 95251’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 · 95251
RVUs × geographic indexes × conversion factor
Work0.68
0.68 RVUs× 1.000 GPCI
Practice expense0.32
0.32 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.0500
Conversion factor
$33.4009
Medicare rate
$35.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,493
- Code
- 95251
- Physician work
- 0.68
- Practice expense
- 0.32
- Malpractice
- 0.05
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.68 | × 1.000 | 0.6800 |
| Practice expense | 0.32 | × 1.000 | 0.3200 |
| Malpractice | 0.05 | × 0.998 | 0.0499 |
| Total RVUs | 1.0499 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$35.07
Office: (0.68 × 1 + 0.32 × 1 + 0.05 × 0.998) × $33.4009 = $35.07
Facility: (0.68 × 1 + 0.32 × 1 + 0.05 × 0.998) × $33.4009 = $35.07
Payment rules and modifiers for 95251
The CMS indicators that decide how 95251 is paid alongside other services.
CMS payment indicators · 95251
CGM interpretation, analysis, interpretation, and report
| 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 | 2 | Professional component only. |
How 95251 has changed in Montana
95251 · Office / nonfacility
$35.07
Effective 2026-10-01
The base rate is $1.78 higher than on 2025-10-01, moving from $33.29 to $35.07 (5.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$33.29changed to$35.07
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.70 changed to 0.68
- Practice expense RVU 0.29 changed to 0.32
- Malpractice RVU 0.04 changed to 0.05
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$34.26changed to$33.29
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$33.70changed to$34.26
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$34.54changed to$33.70
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.28 changed to 0.29
January 1, 2023
RVU23A
$35.27changed to$34.54
- Conversion factor 34.6062 changed to 33.8872
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$35.56changed to$35.27
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$37.36changed to$35.56
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.27 changed to 0.28
- Malpractice RVU 0.05 changed to 0.04
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$37.31changed to$37.36
- Conversion factor 36.0391 changed to 36.0896
- Malpractice RVU 0.04 changed to 0.05
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$37.63changed to$37.31
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.28 changed to 0.27
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$45.27changed to$37.63
- Conversion factor 35.8887 changed to 35.9996
- Work RVU 0.85 changed to 0.70
- Practice expense RVU 0.34 changed to 0.28
- Malpractice RVU 0.05 changed to 0.04
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$44.44changed to$45.27
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 0.33 changed to 0.34
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$44.16changed to$44.44
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.04 changed to 0.05
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$43.94changed to$44.16
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$44.30changed to$43.94
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.34 changed to 0.33
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$42.67changed to$44.30
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 0.36 changed to 0.34
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $42.67
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $35.07 | $35.07 | RVU26D |
| 2026-07-01 | $35.07 | $35.07 | RVU26C |
| 2026-04-01 | $35.07 | $35.07 | RVU26B |
| 2026-01-01 | $35.07 | $35.07 | RVU26A |
| 2025-10-01 | $33.29 | $33.29 | RVU25D |
| 2025-07-01 | $33.29 | $33.29 | RVU25C |
| 2025-04-01 | $33.29 | $33.29 | RVU25B |
| 2025-01-01 | $33.29 | $33.29 | RVU25A |
| 2024-10-01 | $34.26 | $34.26 | RVU24D |
| 2024-07-01 | $34.26 | $34.26 | RVU24C |
| 2024-04-01 | $34.26 | $34.26 | RVU24B |
| 2024-03-09 | $34.26 | $34.26 | RVU24AR |
| 2024-01-01 | $33.70 | $33.70 | RVU24A |
| 2023-10-01 | $34.54 | $34.54 | RVU23D |
| 2023-07-01 | $34.54 | $34.54 | RVU23C |
| 2023-04-01 | $34.54 | $34.54 | RVU23B |
| 2023-01-01 | $34.54 | $34.54 | RVU23A |
| 2022-10-01 | $35.27 | $35.27 | RVU22D |
| 2022-07-01 | $35.27 | $35.27 | RVU22C |
| 2022-04-01 | $35.27 | $35.27 | RVU22B |
| 2022-01-01 | $35.27 | $35.27 | RVU22A |
| 2021-10-01 | $35.56 | $35.56 | RVU21D |
| 2021-07-01 | $35.56 | $35.56 | RVU21C |
| 2021-04-01 | $35.56 | $35.56 | RVU21B |
| 2021-01-01 | $35.56 | $35.56 | RVU21A |
| 2020-10-01 | $37.36 | $37.36 | RVU20D |
| 2020-07-01 | $37.36 | $37.36 | RVU20C |
| 2020-04-01 | $37.36 | $37.36 | RVU20B |
| 2020-01-01 | $37.36 | $37.36 | RVU20A |
| 2019-10-01 | $37.31 | $37.31 | RVU19D |
| 2019-07-01 | $37.31 | $37.31 | RVU19C |
| 2019-04-01 | $37.31 | $37.31 | RVU19B |
| 2019-01-01 | $37.31 | $37.31 | RVU19A |
| 2018-10-01 | $37.63 | $37.63 | RVU18D |
| 2018-07-01 | $37.63 | $37.63 | RVU18C |
| 2018-04-01 | $37.63 | $37.63 | RVU18B |
| 2018-01-01 | $37.63 | $37.63 | RVU18AR1 |
| 2017-10-01 | $45.27 | $45.27 | RVU17D |
| 2017-07-01 | $45.27 | $45.27 | RVU17C |
| 2017-04-01 | $45.27 | $45.27 | RVU17B |
| 2017-01-01 | $45.27 | $45.27 | RVU17A |
| 2016-10-01 | $44.44 | $44.44 | RVU16D |
| 2016-07-01 | $44.44 | $44.44 | RVU16C |
| 2016-04-01 | $44.44 | $44.44 | RVU16B |
| 2016-01-01 | $44.44 | $44.44 | RVU16A |
| 2015-10-01 | $44.16 | $44.16 | RVU15D |
| 2015-07-01 | $44.16 | $44.16 | RVU15C |
| 2015-04-01 | $43.94 | $43.94 | RVU15B |
| 2015-01-01 | $43.94 | $43.94 | RVU15A |
| 2014-10-01 | $44.30 | $44.30 | RVU14D |
| 2014-07-01 | $44.30 | $44.30 | RVU14C |
| 2014-04-01 | $44.30 | $44.30 | RVU14B |
| 2014-01-01 | $44.30 | $44.30 | RVU14A |
| 2013-10-01 | $42.67 | $42.67 | RVU13D |
| 2013-07-01 | $42.67 | $42.67 | RVU13C |
| 2013-04-01 | $42.67 | $42.67 | RVU13B |
| 2013-01-01 | $42.67 | $42.67 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
95251 billing questions
Can 95251 be billed on the same day as an office visit?
Yes. The CGM interpretation can be reported with a separately documented E/M service on the same date. The time and work spent interpreting the CGM data should not also be counted toward the E/M level.
Does 95251 require a face-to-face encounter?
No. The interpretation can be performed from data the patient uploads to a cloud platform or brings to the office. The billable work is the analysis and written report, not a visit.
How often can 95251 be reported?
Report it no more than once per month, regardless of how many times the data are reviewed during that month. The interpretation requires at least 72 hours of monitoring.
Should modifier 26 be appended to 95251?
No. The code already represents the professional interpretation and report. When performed, patient-owned CGM startup and training are described by 95249; setup and recording with practice-provided equipment are described by 95250.
Is 95251 billable when the patient uses their own personal CGM?
Yes. Interpretation of data from a patient-owned device is reported with 95251. Report 95249 only if the practice also performed the startup, hookup, and training for that device.
What documentation supports 95251?
The record should show monitoring dates covering at least 72 hours and a patient-specific interpretation of glucose patterns. It should also document the clinician's recommendations or management changes and the interpreting practitioner's signature.
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
Show the CMS file lines behind this rate
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