When should I use 95251?

CGM data review and interpretation. Once per 30 days regardless of who supplied the device.

What documentation does 95251 require?

- Minimum 72 hours of CGM data. - Interpretation, written report in chart. - Changes to therapy or recommendations.

What are common 95251 billing pitfalls?

- Billing more than once per 30 days. - Billing 95251 without 72 hours of data captured.

How much does 95251 pay in 2026?

2026 work RVU for 95251 is 0.68. National Medicare non-facility allowable is approximately $35.07 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

Procedures · CMS status A

95251

Cont gluc mntr analysis i&r

Ambulatory continuous glucose monitoring; analysis, interpretation and report.

Endo Outpatient IM

Model in calculator →Audit a note

Work RVU

0.68

2026 Medicare pays

$35.07

National GPCI · non-facility · CF $33.4009

RVU anatomyWork 0.68 + Practice 0.32 + Malpractice 0.05 = 1.05 total

Work (your effort)Practice expenseMalpractice

When to use it

CGM data review and interpretation.

Full guidance

Once per 30 days regardless of who supplied the device.

Documentation checklist

✓Minimum 72 hours of CGM data.
✓Interpretation, written report in chart.
✓Changes to therapy or recommendations.

Common pitfalls

!Billing more than once per 30 days.
!Billing 95251 without 72 hours of data captured.

Common modifiers

25 (on E/M)

Common ICD-10 pairings

E10.9E11.9E11.65

Pairs well with

99214

1.92 wRVU

Office o/p est mod 30 min

95249

0.00 wRVU

CGM personal, patient-provided setup

95250

0.00 wRVU

Cont gluc mntr phys/qhp eqp

Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.