How To Use CPT Code 95250

CPT 95250 is a code used for ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95250 procedures.

1. What is CPT 95250?

CPT 95250 is a medical billing code used to report the technical component of ambulatory continuous glucose monitoring (CGM) services. This code is specifically used for monitoring interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours. The services covered under this code include sensor placement, hook-up, calibration of the monitor, patient training, removal of the sensor, and printout of the recording.

2. 95250 CPT code description

The official description of CPT code 95250 is: “Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording.”

3. Procedure

The 95250 procedure involves the following steps:

1. Placement of the subcutaneous sensor, usually in the abdomen, to detect glucose levels in the interstitial tissue fluid.
2. Hook-up of the sensor to the continuous glucose monitoring device.
3. Calibration of the monitor to ensure accurate glucose level readings.
4. Patient training on device calibration, usage, and maintenance.
5. Removal of the sensor after a minimum of 72 hours of continuous monitoring.
6. Downloading of the recorded data and obtaining a printout for review by the healthcare provider.

4. Qualifying circumstances

Patients eligible to receive CPT 95250 services are those who have difficulty regulating their blood glucose levels and require continuous monitoring to better manage their condition. This may include patients with diabetes, hypoglycemia, or other glucose-related disorders. The healthcare provider must determine that the patient would benefit from ambulatory continuous glucose monitoring and that the procedure is medically necessary.

5. When to use CPT code 95250

CPT code 95250 should be used when a healthcare provider determines that a patient requires ambulatory continuous glucose monitoring for a minimum of 72 hours to better manage their blood glucose levels. This code is appropriate for reporting the technical component of the service, including sensor placement, hook-up, calibration, patient training, sensor removal, and recording printout.

6. Documentation requirements

To support a claim for CPT 95250, the following information must be documented:

• Medical necessity for ambulatory continuous glucose monitoring, including the patient’s diagnosis and relevant medical history.
• Details of the sensor placement, hook-up, and calibration process.
• Patient training provided, including instructions on device usage and maintenance.
• Duration of the monitoring period (minimum of 72 hours).
• Sensor removal and data downloading process.
• Printout of the recorded data and healthcare provider’s review and interpretation of the results.

7. Billing guidelines

When billing for CPT code 95250, it is important to remember that this code represents the technical component of the service only. Therefore, modifier 26 or TC should not be appended. For the professional component, the rendering provider should report CPT code 95251. Additionally, CPT 95250 should not be reported more than once per month and should not be reported in conjunction with codes 99091 and 0446T.

8. Historical information

CPT 95250 was added to the Current Procedural Terminology system on January 1, 2002. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2018.

9. Similar codes to CPT 95250

Five similar codes to CPT 95250 and how they differ are:

1. CPT 95251: This code is used to report the professional component of ambulatory continuous glucose monitoring, including data interpretation and report preparation.
2. CPT 99091: This code is used for the collection and interpretation of physiologic data, but it is not specific to glucose monitoring and should not be reported in conjunction with CPT 95250.
3. CPT 0446T: This code is used for remote monitoring of physiologic parameters, including glucose, but it is not specific to ambulatory continuous glucose monitoring and should not be reported with CPT 95250.
4. CPT 82962: This code is used for self-monitoring of blood glucose levels using a glucose meter, which is a different method of monitoring than ambulatory continuous glucose monitoring.
5. CPT 82948: This code is used for laboratory testing of blood glucose levels, which is a different method of monitoring than ambulatory continuous glucose monitoring.

10. Examples

Here are 10 detailed examples of CPT code 95250 procedures:

1. A patient with type 1 diabetes experiencing frequent hypoglycemic episodes undergoes ambulatory continuous glucose monitoring for 72 hours to better understand their glucose patterns and adjust their insulin regimen.
2. A patient with type 2 diabetes on oral medications has uncontrolled blood glucose levels and undergoes a 72-hour ambulatory continuous glucose monitoring to determine the need for insulin therapy.
3. A pregnant patient with gestational diabetes undergoes a 72-hour ambulatory continuous glucose monitoring to optimize glucose control and minimize risks to the fetus.
4. A patient with hypoglycemia unawareness undergoes a 72-hour ambulatory continuous glucose monitoring to detect low blood glucose levels and prevent severe hypoglycemic episodes.
5. A patient with type 1 diabetes using an insulin pump undergoes a 72-hour ambulatory continuous glucose monitoring to fine-tune their basal insulin rates and bolus doses.
6. A patient with type 2 diabetes experiencing nocturnal hypoglycemia undergoes a 72-hour ambulatory continuous glucose monitoring to identify the cause and adjust their treatment plan.
7. A patient with prediabetes undergoes a 72-hour ambulatory continuous glucose monitoring to assess their glucose patterns and determine the need for lifestyle modifications or medication.
8. A patient with type 1 diabetes and a history of diabetic ketoacidosis undergoes a 72-hour ambulatory continuous glucose monitoring to monitor glucose levels and prevent future episodes.
9. A patient with type 2 diabetes and a history of hyperglycemic hyperosmolar syndrome undergoes a 72-hour ambulatory continuous glucose monitoring to monitor glucose levels and prevent future episodes.
10. A patient with type 1 diabetes participating in a clinical trial for a new insulin therapy undergoes a 72-hour ambulatory continuous glucose monitoring to evaluate the effectiveness of the treatment.