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Wiki Continuous Glucose Monitoring CPT 95250

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k.Forrest

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Local Chapter Officer
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Lapeer, MI
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I am trying to determine when this procedure is considered billable. My doctor is a PCP. In the billing dept we were under the assumption that the A1C needed to be over 7.0% in order to meet medical necessity. However, another doctor, an endocrinologist (specialist), said they bill this with just a single high blood sugar level. Now my doctor obviously wants to do the same thing. I need to know what the minimum requirements are for determining medical necessity.
 
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