CPT code 95251: CGM interpretation, analysis, interpretation, and report2026 Medicare rate & RVUs in New York
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.
Medicare pays $34.04–$39.98 for 95251 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. 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 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.
Where 95251 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$34.04 to $39.98
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $39.23 | $39.23 |
| NYC suburbs and Long Island, NY | $39.98 | $39.98 |
| Poughkeepsie and northern NYC suburbs, NY | $37.46 | $37.46 |
| Queens, NY | $39.21 | $39.21 |
| Rest of New York | $34.04 | $34.04 |
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.
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. |
95251 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 95250CGM setupPractice-supplied equipment
- 95250 covers technical work using practice-provided CGM equipment, including sensor placement and recording. 95251 covers the clinician's analysis, interpretation, and written report of the data.
- 95249CGM setupPatient-provided equipment
- 95249 covers startup, hookup, and patient training for a patient-owned CGM. 95251 covers interpretation and report of data from either patient-owned or practice-provided equipment.
- 99091Remote data review30 minutes per 30 days
- 99091 requires at least 30 minutes in a 30-day period to collect and interpret qualifying digitally stored or transmitted physiologic data. Use 95251 for analysis, interpretation, and report of at least 72 hours of CGM data.
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.
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