Billing code 95250: CGM setupMedicare rate & RVUs in Guam
Report this service when a practice places and manages its professional continuous glucose monitor for a patient whose glucose patterns need assessment.
Medicare pays $172.62 for 95250 in the office in Guam (Hawaii, Guam). 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.
On this page 9 sections
What 95250 covers
This service covers the technical work of a professional continuous glucose monitoring session using equipment supplied by the practice. A physician, qualified health care professional, or trained clinical staff member working under appropriate supervision may place the sensor, connect and prepare the monitor, instruct the patient on wearing it, and remove it after data collection. Endocrinology and diabetes practices commonly use it to capture glucose patterns that are not clear from routine readings, including overnight or between-meal trends.
Report the service for the practice’s sensor setup and related technical work, not for analysis of the recorded results. Documentation should support the clinical reason for monitoring and record the setup and sensor removal. CMS classifies 95250 as technical-component-only; a separate code, 95251, covers the interpretation and report when those services are performed. The separate interpretation should be supported by review of the recorded data and a documented report.
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.
95250 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $172.62 | Unavailable |
How the 95250 rate is calculated
Each of 95250’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 · 95250
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense4.52
4.52 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
4.5700
Conversion factor
$33.4009
Medicare rate
$152.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95250
The CMS indicators that decide how 95250 is paid alongside other services.
CMS payment indicators · 95250
CGM setup
| 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. |
95250 compared with similar codes
Compare codes · National
95250 vs 95249 vs 95251: Medicare rates
How to choose
- 95249CGM setup
- Choose 95249 when the patient provides the monitoring equipment; 95250 describes technical setup using practice-supplied professional equipment.
- 95251CGM interpretation
- 95251 represents analysis, interpretation, and reporting of the recorded data. It is separate from the equipment setup and sensor-management work in 95250.
95250 billing questions
How does 95250 differ from 95249?
95250 is for professional monitoring equipment supplied by the practice. 95249 is used when the patient’s own continuous glucose monitoring equipment is set up.
Does 95250 include interpretation of the glucose data?
No. It covers the technical work; report 95251 separately when the data are analyzed and an interpretation and report are completed.
Can 95250 and 95251 be reported for the same monitoring session?
Yes, when both the technical service and the separate analysis, interpretation, and report are performed and documented.
What documentation supports 95250?
Document the clinical reason for professional monitoring, sensor setup, patient instructions, and removal. Keep interpretation findings in the record when 95251 is also reported.
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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