How To Use CPT Code 95251

CPT 95251 refers to the analysis, interpretation, and report of a patient’s continuous glucose monitoring data for a minimum of 72 hours. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95251.

1. What is CPT 95251?

CPT 95251 is a medical billing code used to represent the professional component of a service in which a patient has undergone continuous glucose monitoring (CGM) for at least 72 hours. The provider reviews the data collected from monitoring, analyzes it, interprets it, and creates a written report. This code is specifically for the analysis, interpretation, and report of the CGM data and does not include the technical component of the service.

2. 95251 CPT code description

The official description of CPT code 95251 is: “Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report.”

3. Procedure

1. Patient undergoes continuous glucose monitoring for a minimum of 72 hours using a subcutaneous sensor.
2. CGM data is collected and stored, either in real-time or for later download and review by the provider.
3. Provider reviews the collected data, analyzing and interpreting the patient’s glucose levels.
4. Provider creates a written report based on the analysis and interpretation of the CGM data.

4. Qualifying circumstances

Patients eligible to receive CPT code 95251 services are those who have difficulty regulating their blood glucose levels due to conditions such as type 1, type 2, or gestational diabetes. The continuous glucose monitoring must be performed for a minimum of 72 hours to qualify for this code.

5. When to use CPT code 95251

It is appropriate to bill the 95251 CPT code when a provider has analyzed, interpreted, and created a written report based on a patient’s continuous glucose monitoring data collected over a minimum of 72 hours. This code should not be used for the technical component of the service, such as hooking up the device, recording, disconnecting the device, and downloading and printing data.

6. Documentation requirements

To support a claim for CPT 95251, the following information should be documented:

• Patient’s diagnosis and medical necessity for continuous glucose monitoring.
• Duration of the continuous glucose monitoring (minimum of 72 hours).
• Details of the analysis and interpretation of the CGM data.
• Written report created by the provider, including any recommendations for treatment adjustments based on the analysis.

7. Billing guidelines

When billing for CPT code 95251, keep in mind the following guidelines:

• Do not report 95251 more than once per month.
• Do not report 95251 in conjunction with 99091.
• Do not append modifier 26 or TC, as this code represents the professional component of the service only.
• For the technical component, the rendering provider should report 95250.

8. Historical information

CPT 95251 was added to the Current Procedural Terminology system on January 1, 2006. There have been updates to the code’s descriptor on January 1, 2009, and January 1, 2018.

9. Similar codes to CPT 95251

Five similar codes to CPT 95251 and how they differentiate are:

• CPT 95250: Represents the technical component of the continuous glucose monitoring service, including hooking up the device, recording, disconnecting the device, and downloading and printing data.
• CPT 99091: Collection and interpretation of physiologic data, but should not be reported in conjunction with 95251.
• CPT 99201: Office or other outpatient visit for the evaluation and management of a new patient.
• CPT 99202: Office or other outpatient visit for the evaluation and management of a new patient, with a more detailed history and examination compared to 99201.
• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient, with a more comprehensive history and examination compared to 99202.

10. Examples

Here are 10 detailed examples of CPT code 95251 procedures:

1. A patient with type 1 diabetes undergoes continuous glucose monitoring for 72 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for insulin adjustments.
2. A patient with type 2 diabetes undergoes continuous glucose monitoring for 96 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for oral medication adjustments.
3. A pregnant patient with gestational diabetes undergoes continuous glucose monitoring for 72 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for dietary changes.
4. A patient with type 1 diabetes undergoes continuous glucose monitoring for 120 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for insulin pump adjustments.
5. A patient with type 2 diabetes undergoes continuous glucose monitoring for 72 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for exercise regimen adjustments.
6. A patient with type 1 diabetes undergoes continuous glucose monitoring for 168 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for continuous glucose monitor settings adjustments.
7. A patient with type 2 diabetes undergoes continuous glucose monitoring for 72 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for a combination of medication, diet, and exercise adjustments.
8. A patient with gestational diabetes undergoes continuous glucose monitoring for 96 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for insulin therapy initiation.
9. A patient with type 1 diabetes undergoes continuous glucose monitoring for 72 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for a change in insulin type.
10. A patient with type 2 diabetes undergoes continuous glucose monitoring for 72 hours, and the provider analyzes the data, interprets it, and creates a written report with recommendations for a change in oral medication type.