$140.17–$159.15
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.
On this page
CMS RVU26D · Effective 2026-10-01
95251 CGM interpretation Medicare reimbursement rates in Pennsylvania
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. Compare 95251 office and facility rates across CMS payment localities in Pennsylvania.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 95251 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$34.10–$36.24
2 of 2 localities have a supported rate.
Facility setting
$34.10–$36.24
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Endocrine monitoring
About 95251: Continuous glucose monitoring data interpretation and report
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.
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.
CMS billing rules for 95251
- Professional and technical components
- Professional-component-only code: interpretation and report; a separate code covers the technical portion.
Where the value comes from
- Work RVU0.68 · 65%
- Practice expense (office) RVU0.32 · 30%
- Malpractice RVU0.05 · 5%
841.7K
Medicare services in 2024 · #161 by national volume
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.
95251 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$64.12–$72.87
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.
$53.97–$57.23
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.
Compare 95251 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$36.24
Facility
$36.24
Rest Of Pennsylvania →
Office / nonfacility
$34.10
Facility
$34.10
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,49095199,,Unlisted all/immlg svc/px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,49195249,,Cont gluc mntr pt prov eqp,A,,0.00,2.05,,2.05,NA,0.04,2.09,2.09,3,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,49295250,,Cont gluc mntr phys/qhp eqp,A,,0.00,4.52,,4.52,NA,0.05,4.57,4.57,3,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,49395251,,Cont gluc mntr analysis i&r,A,,0.68,0.32,,0.32,,0.05,1.05,1.05,2,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,49495700,,Eeg cont rec w/vid eeg tech,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
12,49595705,,Eeg w/o vid 2-12 hr unmntr,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
12,49695706,,Eeg wo vid 2-12hr intmt mntr,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00