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CPT code 95251: CGM interpretation, analysis, interpretation, and report2026 Medicare rate & RVUs in West Virginia

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.

CMS RVU26DEffective Oct 1, 2026One payment locality841.7K Medicare services in 2024

In West Virginia, Medicare pays $34.39 for 95251 in the office and $34.39 when it’s performed in a hospital or facility.

$34.39Office (non-facility)
$34.39Hospital or facility
−1.9%vs the national office rate ($35.07)

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.

We’ll open 95251 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 95251 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 West Virginia 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. West Virginia pays $34.39. The RVUs are the same everywhere; the geographic indexes change the dollars.

95251 in West Virginia vs other payment areas
  1. West Virginia · this page$34.39
  2. Los Angeles, CA · California$37.40+$3.01
  3. Washington, DC area · District of Columbia$38.39+$4.00
  4. Miami, FL · Florida$38.06+$3.67
  5. Chicago, IL · Illinois$37.45+$3.06
  6. Manhattan, NY · New York$39.23+$4.84
  7. Alaska · Alaska$46.37+$11.98

Other areas in West Virginia first, then benchmark localities. Bars start at $0.

Every other payment area

95251 in every other Medicare payment locality
Payment localityOfficeFacility
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

95251 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
95251 office rate range by state
State / territoryOffice rate rangeLocalities
AK$46.371
AL$33.011
AR$32.751
AZ$34.501
CA$35.71–$41.5229
CO$35.661
CT$36.701
DC$38.391
DE$34.891
FL$35.44–$38.063
GA$34.24–$35.652
GU$35.831
HI$35.831
IA$33.161
ID$33.341
IL$35.08–$37.454
IN$33.431
KS$33.221
KY$33.741
LA$33.77–$34.672
MA$35.66–$37.892
MD$35.29–$38.393
ME$33.58–$34.362
MI$34.36–$35.842
MN$34.211
MO$33.55–$34.563
MS$33.151
MT$35.071
NC$33.751
ND$34.081
NE$33.211
NH$35.301
NJ$37.12–$38.332
NM$34.521
NV$34.801
NY$34.04–$39.985
OH$34.151
OK$33.551
OR$34.53–$36.192
PA$34.10–$36.242
PR$35.161
RI$35.671
SC$34.011
SD$33.961
TN$33.331
TX$33.99–$35.818
UT$34.261
VA$34.40–$38.392
VI$35.161
VT$34.141
WA$35.53–$38.332
WI$33.471
WV$34.391
WY$34.641

See 95251 in every payment locality

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

Office or facility?

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 West Virginia 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

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 95251 in West Virginia
ComponentRVULocality factorAdjusted
Physician work0.68× 1.0000.6800
Practice expense0.32× 0.8690.2781
Malpractice0.05× 1.4310.0716
Total RVUs1.0296
Conversion factor× 33.4009

Office rate, West Virginia$34.39

Office: (0.68 × 1 + 0.32 × 0.869 + 0.05 × 1.431) × $33.4009 = $34.39

Facility: (0.68 × 1 + 0.32 × 0.869 + 0.05 × 1.431) × $33.4009 = $34.39

Open 95251 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical2Professional component only.

Codes related to 95251

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 95251
CodeHow it relatesOffice range, West Virginia
Often billed with
99214Office visit, established patient, moderate complexityEstablished-patient diabetes follow-up may accompany CGM interpretation when distinct E/M work is documented.$128.87
99213Office visit, established patient, low complexityAn established-patient visit may accompany CGM interpretation when distinct E/M work is documented.$90.10
Used instead
99091Remote data review, 30 minutes per 30 daysMay describe qualifying time-based review of remotely transmitted glucose-meter data rather than CGM interpretation.$54.31

How 95251 has changed in West Virginia

95251 · Office / nonfacility

$34.39

Effective 2026-10-01

The base rate is $1.94 higher than on 2025-10-01, moving from $32.45 to $34.39 (6.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $32.45changed to$34.39

    • 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
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $33.40changed to$32.45

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $32.85changed to$33.40

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $33.60changed to$32.85

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.28 changed to 0.29
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $34.20changed to$33.60

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $34.48changed to$34.20

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $35.86changed to$34.48

    • 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
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $35.43changed to$35.86

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.04 changed to 0.05
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $35.70changed to$35.43

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 0.28 changed to 0.27

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $43.15changed to$35.70

    • 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
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $42.61changed to$43.15

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.33 changed to 0.34
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $42.30changed to$42.61

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.04 changed to 0.05

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $42.09changed to$42.30

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $42.38changed to$42.09

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.34 changed to 0.33
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $40.73changed to$42.38

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.36 changed to 0.34
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $40.73

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$34.39$34.39RVU26D
2026-07-01$34.39$34.39RVU26C
2026-04-01$34.39$34.39RVU26B
2026-01-01$34.39$34.39RVU26A
2025-10-01$32.45$32.45RVU25D
2025-07-01$32.45$32.45RVU25C
2025-04-01$32.45$32.45RVU25B
2025-01-01$32.45$32.45RVU25A
2024-10-01$33.40$33.40RVU24D
2024-07-01$33.40$33.40RVU24C
2024-04-01$33.40$33.40RVU24B
2024-03-09$33.40$33.40RVU24AR
2024-01-01$32.85$32.85RVU24A
2023-10-01$33.60$33.60RVU23D
2023-07-01$33.60$33.60RVU23C
2023-04-01$33.60$33.60RVU23B
2023-01-01$33.60$33.60RVU23A
2022-10-01$34.20$34.20RVU22D
2022-07-01$34.20$34.20RVU22C
2022-04-01$34.20$34.20RVU22B
2022-01-01$34.20$34.20RVU22A
2021-10-01$34.48$34.48RVU21D
2021-07-01$34.48$34.48RVU21C
2021-04-01$34.48$34.48RVU21B
2021-01-01$34.48$34.48RVU21A
2020-10-01$35.86$35.86RVU20D
2020-07-01$35.86$35.86RVU20C
2020-04-01$35.86$35.86RVU20B
2020-01-01$35.86$35.86RVU20A
2019-10-01$35.43$35.43RVU19D
2019-07-01$35.43$35.43RVU19C
2019-04-01$35.43$35.43RVU19B
2019-01-01$35.43$35.43RVU19A
2018-10-01$35.70$35.70RVU18D
2018-07-01$35.70$35.70RVU18C
2018-04-01$35.70$35.70RVU18B
2018-01-01$35.70$35.70RVU18AR1
2017-10-01$43.15$43.15RVU17D
2017-07-01$43.15$43.15RVU17C
2017-04-01$43.15$43.15RVU17B
2017-01-01$43.15$43.15RVU17A
2016-10-01$42.61$42.61RVU16D
2016-07-01$42.61$42.61RVU16C
2016-04-01$42.61$42.61RVU16B
2016-01-01$42.61$42.61RVU16A
2015-10-01$42.30$42.30RVU15D
2015-07-01$42.30$42.30RVU15C
2015-04-01$42.09$42.09RVU15B
2015-01-01$42.09$42.09RVU15A
2014-10-01$42.38$42.38RVU14D
2014-07-01$42.38$42.38RVU14C
2014-04-01$42.38$42.38RVU14B
2014-01-01$42.38$42.38RVU14A
2013-10-01$40.73$40.73RVU13D
2013-07-01$40.73$40.73RVU13C
2013-04-01$40.73$40.73RVU13B
2013-01-01$40.73$40.73RVU13AR

Price 95251 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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
RVUs for 95251PPRRVU2026_Oct_nonQPP.csv, line 12,493 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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