Wiki CGM 95249

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anajet1

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Good morning everyone,



Does anyone have experience billing for CGM services in your practice? Specifically the Personal CGM 95249 (Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording).



I have a provider who is wanting to know more information and has some specific questions that I’ve had a difficult time nailing down in my research.



Does anyone know if this can be billed if a sample is given to the patient? The provider is saying they would put the sample on the patient in office so they didn’t have to get their prescription filled and come back in.



In my research I have also read that a smartphone may not be an acceptable receiver device because it is not considered FDA approved. Does the CGM have to be used in conjunction with a reader, other than a smartphone?



My provider is also wanting to know if all components of the code description have to be performed in order for the service to be billed?



Any help you all can give is greatly appreciated!
 
There is a lot of info if you search CGM or the codes or continuous glucose monitor here: https://www.cms.gov/medicare-coverage-database/search.aspx
AACE https://pro.aace.com/cgm/toolkit/billing-codes

Most payers have extensive rules and guidelines on this also. Examples:
Of course manufacturers have info too: https://www.medtronic.com/us-en/healthcare-professionals/reimbursement/diabetes.html

I would think since the sample is "owned by the patient" since it was given to them you would use 95249.

Re: smart phone: https://provider.dexcom.com/coding#
If a patient has been using their Dexcom receiver and then switches to a compatible smart device† to display their glucose data, can the provider bill CPT code 95249 for this training?
It is highly unlikely any commercial payers would cover training costs for devices that are not reimbursed. (Medicare does not currently reimburse for a CGM system if a smart device is solely used to display glucose data. The patient must have a receiver to use in conjunction with the smart device.) However, providers should check with individual payers for specifics on billing when a patient switches to using a smart device for glucose data display.

CMS examples, be sure you search in your MAC:
CGM devices that solely display results on a smartphone and do not have a stand-alone receiver or integration into an insulin infusion pump do not meet the definition of DME and will be denied as non-covered (no benefit).
 
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